Abstract 11912: Pregabalin Use Increases the Risk of Acute Heart Failure in Patients With Heart Failure: A Population-Based Study

Abstract

Introduction: Pregabalin, a structural analog to λ-aminobutyric acid, is prescribed for neurological disorders. Through actions to cause sodium/water retention, the agent may increase the risk of acute heart failure (AHF). Methods: We performed a retrospective cohort study using a repository of healthcare records obtained from a large U.S. academic healthcare system. HF patients were identified between 1/1/2016-12/31/2020. Patients who had initiated treatment with pregabalin were compared to patients with no post-HF pregabalin over a 365-day post-pregabalin period or post-HF period. Study outcomes were per-patient per-year (PPPY) emergency department (ED) admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations. Outcomes encounters were adjudicated by a HF diagnosis (ICD-10, I50.x) at any position. We tested the association between the pregabalin exposure and outcomes using generalized linear regression and Cox-proportional hazard regression approach. Results: The study cohort included 483 pregabalin-HF patients and 21,150 pregabalin-naïve HF patients. The pregabalin-HF patients age was (mean±SEM: 62.2±0.7 vs. 66.2±0.1 years, p <0.0001) and more females (54.9% vs, 44.4%, p <0.0001) than pregabalin-naïve HF patients. Charleston comorbidity score was 3.66±0.14 vs. 3.23±0.02 ( p =0.007). Pregabalin use was associated with a 13% increase in PPPY AHF hospitalizations ( p <0.036). A 15% increase in the PPPY ED pregabalin admissions was noted ( p =0.1142). Pregabalin ED admission or AHF hospitalization were 1.492 (95% CI: 1.204 ̶ 1.850 [ p =0.0003]) and 1.112 (95% CI: 0.922 ̶ 1.340 [ p =0.2663]). Conclusion: This retrospective cohort study shows pregabalin is associated with an increased risk of AHF in patients with existing HF. Pregabalin prescribing in HF should be considered with caution. Further signal evaluation to test the robust association between pregabalin and AHF is warranted.