Presentation (CTI)

OBJECTIVES: Opioid tapering has increased in recent years with the implementation of national prescribing guidelines. This study aimed to examine the association of opioid tapering with takotsubo cardiomyopathy (TCM) and major adverse cardiovascular events (MACE) in older Medicare beneficiaries.
METHODS: A case-crossover design was employed using 5% Medicare administrative claims data (2012-2020). Older adults (≥65 years) with TCM or MACE (composite of myocardial infarction, stroke, or cardiovascular death) were identified, and the date of the first occurrence was designated as the index date. Beneficiaries were required to have long-term opioid therapy episode, defined as ≥45 days of opioid possession within 90-day window occurring between day 180 and day 90 before the index date. Any opioid tapering was defined as a ≥15% reduction in mean daily morphine milligram equivalents (MME) during the case period (first month) compared with the washout period (second month), or during the control period (third month) compared with the baseline period (fourth month) before the index date. Rapid tapering was defined as a ≥40% reduction in mean daily MME. The association between opioid tapering and outcomes was estimated using conditional logistic regression.
RESULTS: A total of 426 TCM cases and 28,321 MACE cases were identified. Any opioid tapering was associated with significantly increased odds of TCM (odds ratio [OR] = 1.55; 95% confidence interval [CI]: 1.03-2.33) and MACE (OR = 1.44; 95% CI: 1.37-1.51) compared with no opioid tapering. Rapid opioid tapering was associated with higher odds of TCM (OR = 2.27; 95% CI: 1.24-4.16) and MACE (OR = 1.92; 95% CI: 1.80-2.05) compared with no rapid opioid tapering.
CONCLUSIONS: Both any and rapid opioid tapering were associated with increased risk of adverse cardiovascular outcomes. These findings lend evidence for patient-centered, gradual opioid dose reductions with enhanced monitoring and support to mitigate cardiovascular harm among older adults.