Objective The goal of this study is to determine the strength of association between treatment with triptans and acute myocardial infarction, heart failure, and death. Background Case reports in the literature have raised concerns over an association between treatment of migraine headaches with triptans and cardiovascular events. This study aims to systematically evaluate this association in a contemporary population‐based cohort. We hypothesized that triptan exposure is not associated with increased cardiovascular events. Methods A retrospective cohort study was conducted within an integrated healthcare delivery system in Southern California. From January 2009 to December 2018, 189,684 patients age ≥18 years had a diagnosis of migraine. In this group, 130,656 were exposed to triptans. Patients treated with triptans were matched 1:1 to those not exposed to triptans by using a propensity score. The primary outcome was acute myocardial infarction; secondary outcomes were heart failure, all‐cause death, and combined acute myocardial infarction, heart failure, and death. Results The incidence rate of acute myocardial infarction was 0.67 per 1000 person‐year in triptan‐exposed vs 1.44 per 1000 person‐year in not exposed patients. In propensity‐matched analyses, the adjusted hazard ratio for triptan exposure was 0.95 (95% confidence interval [CI] 0.84‐1.08) for acute myocardial infarction; 1.00 (95% CI 0.93‐1.08) for all‐cause death; 0.93 (95% CI 0.81‐1.08) for heart failure; and 0.99 (95% CI 0.93‐1.06) for a composite of acute myocardial infarction, heart failure, or death. Sensitivity analyses focusing on stratified subgroups based on age, gender, ethnicity, and several cardiac risk factors also revealed no significant association between triptan exposure and cardiovascular events. Conclusions No association was found between exposure to triptans and an increased risk of cardiovascular events. These data provide reassurance regarding the cardiovascular safety of utilizing triptans for the medical management of migraine headaches.
Background: Nonagenarians represent a growing population in the United States. Cardiac stress testing is commonly used for risk stratification in patients with chest pain. However, there is limited evidence on the benefits of stress testing in nonagenarians. Aims: The goal of this study was to investigate the utilization of cardiac stress testing in nonagenarian evaluated in outpatient clinics for chest pain, and to evaluate the incremental prognostic value of stress testing in this population. Methods: This is a retrospective observational study that included patients 90 years and above who presented for outpatient evaluation of chest pain. Referral for cardiac stress testing was captured using electronic health records. Patients were followed for one year. The associations between cardiac stress testing and subsequent cardiac catheterization, coronary revascularization, and myocardial infarction were evaluated using logistic regression models. Results: Between 2017 and 2021, 11763 patients 90 years and above presented to a clinic visit with a chief complaint of chest pain. There were 50.3% male, 61.4% White, 9.0% Black, 20.0% Hispanic, and 9.3% Asian. In this group, 320 (2.7%) underwent cardiac stress testing. Patients referred for testing had fewer cardiac risk factors, with a lower prevalence of hypertension, hyperlipidemia, and diabetes. At one year of follow-up, 6.9% of patients in the stress test group underwent cardiac catheterization, compared to 2.5% of patients in the no testing group (adjusted OR 2.87, 95% CI 1.81-4.57). Revascularization occurred in 0.63% patients in the stress testing group compared to 0.78% in the no testing group (adjusted OR 0.78, 95% CI 0.19-3.21). Myocardial infarction occurred in 3.4% in the stress testing group compared to 4.4% in the no testing group (adjusted OR 1.67, 95% CI 0.79-2.9). Conclusion: Among nonagenarians who underwent outpatient evaluation of chest pain, cardiac stress testing was associated with a significantly increased odds of subsequent cardiac catheterization, but no difference in revascularization or myocardial infarction. These observations suggest the clinical benefits of stress testing in nonagenarians may be limited.
Background: Palpitations represent a common complaint in primary care clinics. Although usually benign, palpitations are occasionally a manifestation of cardiac arrhythmias. Aims: This study aimed to investigate whether there are gender differences in the cardiac testing pattern and clinical outcomes of patients evaluated in outpatient clinics for palpitations. Methods: This is a retrospective observational study that included adult men and women who presented to an outpatient primary care or cardiology office in an integrated health system in California with a chief complaint of palpitations. Cardiac testing pattern was captured using electronic health records. The primary endpoint was hospitalization for arrhythmia at one year. The secondary endpoint was all-cause mortality at one year. Logistic regression models were constructed to evaluate the association between female gender and the outcomes. Results: Between 2017 and 2021, 89,680 patients were evaluated for palpitations, among whom 61,064 (68.1%) were women. A high proportion of women were Hispanic. Women were more likely to be obese and less likely to have hypertension, diabetes, atrial fibrillation, heart failure, or a history of myocardial infarction. A slightly higher proportion of women were started on beta-blockers (12.8% women vs. 12.2% men, p=0.004). Women were more likely to be referred for cardiac rhythm monitoring (19.8% women vs. 18.8% men, p <0.001). At one year, women had a lower rate of hospitalization for arrhythmias (0.5% in men versus 0.3% in women, adjusted OR 0.73, 95% CI 0.58-0.91). All-cause mortality was also lower for women at one year (adjusted OR 0.55, 95% CI 0.48-0.62). Conclusion: Among patients with palpitations, women were more likely than men to be treated with beta-blockers and referred for cardiac rhythm monitoring. Women had a better clinical prognosis, with a lower risk of hospitalization for arrhythmias and death at one year.
