Effects of Benzodiazepines on Heart Failure Outcomes and Adverse Events: A Systematic Review and Meta-Analysis

The effects of benzodiazepines (BZDs) for insomnia on heart failure (HF) remain unclear, particularly among high-risk populations. Relevant studies were retrieved by searching seven databases from inception to August 7, 2025. Hazard ratios (HRs) or risk ratios estimated for related HF outcomes were extracted. Meta-analyses were conducted using a random-effects model, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Eleven studies met the inclusion criteria, with follow-up durations ranging from 180 days to 15 years. The meta-analysis demonstrated that BZD use was associated with increased risks of HF incidence (HR = 1.41, 95% confidence interval (CI) 1.16–1.72) and HF hospitalization (HR = 1.29, 95% CI 1.01–1.65) compared to non-use. BZD use also suggested an increased risk of HF hospitalization and rehospitalization compared to antipsychotics, z-drugs, and suvorexant. Benzodiazepine use was associated with an increased risk of HF-related outcomes. Since most of the included studies were observational, these findings indicate associations rather than causal relationships. BZDs should be used with caution among populations at risk of HF when treating insomnia.