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Epilepsy Associated With Increased Risk of Heart Failure

A stronger association between the 2 conditions was seen in younger patients and men with epilepsy than their counterparts in the matched cohort of more than 9000 individuals.

A recent study found patients with late-onset epilepsy had a significantly increased risk of heart failure when compared with patients without epilepsy. Investigators highlighted the need for additional study of extracerebral comorbidities in this patient population. 

A total of 9165 patients with late-onset epilepsy and a matched cohort of 9165 patients without late-onset epilepsy were included in the retrospective study. Mean age was 74.4 years (standard deviation, 18.3), and 53.5% of patients were women. Investigators found that within 10 years of the index date—defined as the date of follow up at one of 1274 general practices in Germany between January 2005 and December 2018—28.6% of patients with epilepsy had been diagnosed with heart failure, compared with 20.4% of patients without epilepsy (log-rank P <.001). The index date for patients without epilepsy was defined as a randomly selected visit within the same date range (January 2005-December 2018). 

When comparing cases between both cohorts, there were 36.3 cases per 1000 patient years in the epilepsy group vs 23.1 cases per 1000 patient years in the nonepilepsy group. Regression analyses showed a strong significant association between epilepsy and heart failure incidence (HR, 1.56; P <.001), with a stronger association in men (HR, 1.56; P <.001) compared with women (HR, 1.49; P <.001). The HR was reduced from 2.62 (P <.001) in patients between the ages of 60-65 years to 1.21 (P = .015) in those 80 years and up. 

“Like epilepsy in the field of neurology, heart failure is an unresolved problem in the field of internal medicine. Both are associated with considerable limitations with regard to the quality of life and the prognosis of those affected,” first author Corinna Doege, MD, department of neuropediatrics, Center of Pediatrics and Adolescent Medicine, Central Hospital, Bremen, Germany, et al wrote. “It is important to note that our study does not show a causal relationship between heart failure and epilepsy, but instead indicates a statistical association between both conditions. To the best of our knowledge, the relationship between the 2 conditions has not been studied extensively, but there are new theories on the relationship between epilepsy and cardiovascular disease that also suggest possible mechanisms of heart failure development in patients with epilepsy. This is where the term ‘epileptic heart’ comes from.”

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Included patients were required to be aged 60 years or older and have a follow-up visit at least 12 months prior to the index date. Patients who had received a diagnosis of heart failure before the index date were excluded. Study data was acquired from the IQVIA Disease Analyzer database, which includes approximately 3% of outpatient practices in Germany. 

Investigators noted certain “unavoidable” limitations resulting from the database analysis and study design, primarily the potential for misclassification of diagnoses or coding missing from the ICD-10 system. Distinguishing between patients who had heart failure with preserved pump function vs those with reduced pump function was also not possible.

“Our study, together with other similar works, opens the door for further functional studies on possible causal relationships between both entities and involved signaling pathways. In the long run, this could improve our understanding of the development of both diseases and possibly help to improve the therapy provided to these particularly vulnerable patients,” Doege et al wrote. “If the data indicating an association between both entities are confirmed in further studies, this may also highlight the need for specific cardiovascular screening programs for patients with epilepsy in the medium term.”

REFERENCE
Doege C, Luedde M, Kostev K. Epilepsy is associated with an increased incidence of heart failure diagnoses. Epilepsy Behav. Published online October 31, 2021. doi:10.1016/j.yebeh.2021.108393