Outcomes Following Benzodiazepine Therapy in Patients With Acute Heart Failure

In the short- and medium-term, benzodiazepine therapy in patients with acute heart failure does not worsen prognosis.

Benzodiazepine (BZD) therapy in patients admitted for acute heart failure (HF) is safe and not associated with a worse prognosis in the short- to medium-term, according to a study in the International Journal of Cardiology.

The prospective EPICTER study consecutively enrolled patients admitted for acute HF. Eligible participants were aged older than 18 years, admitted to the hospital before 8:00 am on the day of data collection, and had HF as the main cause of admission. Data came from 74 Spanish hospitals

The primary outcome was all-cause mortality at day 7. Secondary outcomes included all-cause mortality at days 30 and 180, as well as hospital readmissions and emergency room visits, both at 180 days.

The participants were categorized into 2 groups depending on whether they were receiving treatment with BZDs during admission. A descriptive analysis of the data and a propensity score matching analysis were performed.

The analyses included 1855 patients, 639 were prescribed BZDs (34.4%; mean age, 78.7±10.8 years; 51.8% women) compared with 1216 who were not treated with BZDs (65.6%; mean age, 79.8±10.6 years; 52.8% women). Participants in the BZD group had more cardiac comorbidities (myocardial infarction and previous HF) and noncardiac comorbidities (cerebrovascular disease, peripheral artery disease, anemia, and cognitive impairment).

In this scenario, our data support that BZDs can be safely used for symptomatic relief.

Mortality rates were significantly higher in the group of patients treated with BZDs at 7 days (8.8% vs 3.4%), 30 days (18.3% vs 11.8%), and 180 days (37.1% vs 27.6%). No differences were found for readmissions and visits to the emergency room.

After propensity score calculation, the model showed an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.69-0.74) and a Hosmer-Lemeshow goodness-of-fit test P-value of 0.59. There were 381 balanced paired cases following propensity score matching.

In the propensity-matching cohort, treatment with BZDs was not associated with an increased risk of mortality at day 7 (7.6% vs 5.2%; adjusted odds ratio [aOR], 1.49; 95% CI, 0.83-2.68; P =.186), at 30 days (15.0% vs 15.2%; aOR, 0.98; 95% CI, 0.66-1.96; P =.919), or at 180 days (32.3% vs 30.2%; aOR, 0.91; 95% CI, 0.67-1.23; P =.901).

The patients who received BZDs also did not have an increased rate of readmissions for HF (37.3% vs 37.8%; aOR, 1.02; 95% CI, 0.76-1.37; P =.881) or visits to the emergency room for HF (36.2% vs 31.8%; aOR, 1.22; 95% CI, 090-1.65; P =.194) compared with not taking BZDs.

Limitations of the study include the lack of randomization and unmeasured variables that could have biased the results. Also, differences occurred in the proportion of patients with cerebrovascular disease, and a significant number of patients were enrolled in the EPICTER study with no data on BZD treatment or were lost to follow-up. Furthermore, the study did not assess whether patients had other side effects from the therapy.

“Patients admitted for acute HF taking BZDs have advanced heart disease, severe symptoms, and need more intensive treatment,” wrote the study authors. “In this scenario, our data support that BZDs can be safely used for symptomatic relief.”


Salamanca-Bautista P, Romero-Correa M, Formiga F, et al; on behalf of the EPICTER Investigators group. Safety of benzodiazepines in patients with acute heart failure: a propensity score-matching study. Int J Cardiol. Published online April 14, 2023. doi: 10.1016/j.ijcard.2023.04.014