Benzodiazepines use and mortality in chronic heart failure

Abstract

Introduction: The prognostic implications of BZD in Heart Failure (HF) are still unknown.

Objectives: To assess the association of BZD use with all-cause death in ambulatory chronic HF patients.

Patients and methods:  Retrospective cohort study of ambulatory HF patients with left ventricular systolic dysfunction (LVSD). Patients were followed up until January 2021 and all-cause mortality was the primary endpoint. A Cox-regression analysis was used to assess the association between BZD use and all-cause mortality. Subgroup analyses were performed considering age, sex, body mass index (BMI), respiratory disease, chronic kidney disease (CKD) and New York Heart Association (NYHA) class. Multivariable models were built accounting for confounders.

Results: We studied 854 patients, 69% male, mean age 71(13) years, 51% had severe LSVD, and 242 (28.3%) used BZD regularly. During a median follow-up of 46 months, 443 patients died (51.9%). BZD use portended no crude survival disadvantage as a whole and in subgroup analysis according to sex, respiratory disease, BMI, and NYHA class. BZD use was not mortality-associated among patients ≤75 years, however in those >75 years the HR of all-cause death was 1.30, (0.99-1.69), p=0.06. BZD use seemed safe in patients without CKD but in those with CKD was associated with worse survival - HR 1.33, (1.02-1.73). In a multivariate-adjusted analysis, the use of BZD was independently associated with increased death-risk: HR=1.36 (1.06-1.75).

Conclusions: Patients medicated with BZD presented a 36% higher risk of dying. BZD should probably be used with caution particularly in older HF patients and in those with CKD.