The Relationship Between Valproate and Lamotrigine/Levetiracetam Use and Prognosis in Patients With Epilepsy and Heart Failure: A Danish Register-Based Study

J Card Fail. 2022 Apr;28(4):630-638. doi: 10.1016/j.cardfail.2021.07.020. Epub 2021 Aug 24.

Abstract

Objective: To compare the hazard for all-cause mortality and mortality due to heart failure (HF) between valproate (VPA) and levetiracetam (LEV)/lamotrigine (LTG) users in patients aged ≥ 65 with comorbidities of epilepsy and HF.

Methods: This was a cohort study using Danish registers during the period from January 1996 to July 2018. The study population included new users of LTG, LEV or VPA. A Cox regression model was used to compute crude and adjusted hazard ratios for the outcome, using an intention-to-treat approach. Average treatment effects (eg, 1-year absolute risks), risk differences and the ratio of risks were computed using the G-formula based on a Cox regression model for the outcomes at the end of the follow-up period.

Results: We included 1345 subjects in the study population. VPA users (n = 696), when compared to LTG/LEV users (n = 649), had an increased hazard of mortality due to HF (hazard ratio [HR] 2.39; 95% CI 1.02-5.60) and to all-cause mortality (HR 1.37; 95% CI 1.01-1.85) in both crude and adjusted analyses. The 1-year absolute risks for all-cause mortality were 29% (95% CI 25%-33%) and 22% (95% CI 18%-26%) for VPA and LTG/LEV users. For mortality due to HF, 1-year absolute risks were 5% (95% CI 3%-7%) and 2% (95% CI 1%-4%) for VPA and LTG/LEV users. The average risk ratio, with LTG/LEV as the reference group, was 1.31 (95% CI 1.02-1.71) for all-cause mortality and 2.35 (95% CI 1.11-5.76) for HF mortality.

Conclusion: In older people with HF and epilepsy, treatment with VPA was associated with a higher risk of all-cause and HF mortality compared to treatment with LTG and LEV.

Keywords: Epilepsy; antiseizure medications; heart failure; older patients; prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticonvulsants / adverse effects
  • Cohort Studies
  • Denmark / epidemiology
  • Epilepsy* / drug therapy
  • Epilepsy* / epidemiology
  • Heart Failure* / drug therapy
  • Heart Failure* / epidemiology
  • Humans
  • Lamotrigine / therapeutic use
  • Levetiracetam / therapeutic use
  • Prognosis
  • Valproic Acid / therapeutic use

Substances

  • Anticonvulsants
  • Levetiracetam
  • Valproic Acid
  • Lamotrigine