Sleeping Pills May Worsen Heart Failure

Heart failure patients who took benzodiazepines had higher death rate

(RxWiki News) Sleep is a crucial part of good health, and when people find it nearly impossible to fall or stay asleep, medication may help. However, some sleep medications may be dangerous for certain heart failure patients.

Benzodiazepines, commonly prescribed to help people sleep, were tied to an eight-fold higher risk of death among heart failure patients with preserved ejection fraction (HFpEF) compared to patients with the same kind of heart failure who did not take sleeping pills.

People with HFpEF have normal ejection fractions (an indication of how well the heart is pumping) of 55 percent or higher, but also display symptoms of heart failure, such as shortness of breath or fatigue.

"Tell your cardiologist about all the medications you're taking."

This research was led by Masahiko Setoguchi, MD, of the Tokyo Yamate Medical Center in Japan.

The researchers did a retrospective analysis of 111 heart failure patients admitted to Tokyo Yamate Medical Center between 2011 and 2013.

These researchers had previously noted that the heart function of people with heart failure worsened with repeated hospitalizations, and wondered if it could be medications prescribed when the patients were discharged from the hospital.

They looked at the medications, laboratory tests, coexisting medical problems, vital signs (such as blood pressure and pulse) and scans taken of the chest and heart of these patients.

After patients were discharged from the hospital, they were followed for 180 days to see how many died of cardiovascular-related causes and how many were readmitted to the hospital for heart failure.

The patients were divided into two groups. One group had the HFpEF type of heart failure.  The other type of heart failure is known as HFrEF (heart failure with reduced ejection fraction), which means these people had ejection fractions of 50 percent or lower.

There were 47 patients with HFpEF, and 15 of these patients either died or were readmitted to hospital within 180 days of their initial admission. The only differences between the patients with negative outcomes and the others with HFpEF was that this group with bad outcomes took benzodiazepines (sleeping pills), had different amounts of sodium in their blood, or had different hemoglobin levels (the molecule in red blood cells that carry oxygen).

The researchers noted that those who took benzodiazepines were eight times more likely to be readmitted to the hospital or die.

There were 64 patients with the other type of heart failure known as HFrEF. Of these patients, 24 either died or had to be readmitted to hospital for heart failure. Those patients who were given blood pressure medication when discharged from their initial hospital visit were about 25 percent less likely to be readmitted or die within 180 days.

“The main finding of our study is that HFpEF patients prescribed sleeping pills have an increased risk of cardiovascular events,” Dr. Setoguchi said in a press release from the European Society of Cardiology. “The number of HFpEF patients is increasing and becoming a larger proportion of heart failure patients overall. Our results therefore are of growing relevance to heart failure patients and the professionals who treat them."

Benzodiazepine hypnotics may cause the heart to work less well, he suggested. They also may cause a person to have difficulty breathing, which could worsen sleep disordered breathing, causing deaths or readmissions to hospital, he added.

Dr. Setoguchi said more research is needed, a thought that was echoed by David Rawitscher, MD, FACC, who specializes in treating congestive heart failure at The Heart Hospital Baylor Plano in Texas.

“This study encompasses a very small group of patients (47) with a limited type of heart failure (preserved ejection fraction) and is an observational trial,” Dr. Rawitscher told dailyRx News. "It does raise an interesting question and may warrant additional study, but by itself, will not change practice.”

It may be that those with more severe heart failure have the most difficulty sleeping, he suggested, a finding that may eventually help doctors screen for patients who have more serious heart failure by finding out which ones report sleep issues.

“To actually draw any clinically meaningful conclusions we would need a study of several hundred patients with half getting a placebo sleeping pill and have getting an active sleeping pill and then measuring outcomes," Dr. Rawitscher added.

On occasion, Dr. Rawitscher said he does prescribe benzodiazepines to a select group of his patients with heart failure, but he usually recommends that his patients practice good sleep hygiene, which involves doing things like avoiding caffeine before bed or napping during the day to sleep better at night.

Dr. Setoguchi presented the abstract at the Heart Failure Congress 2014 on May 17 in Athens, Greece. Findings present at conference should be considered preliminary until published in a peer-reviewed journal.

Review Date: 
May 21, 2014