Heart Failure Management

Contraindicated Medications

• Non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and thiazolidinediones (glitazones) are the primary drug classes contraindicated in heart failure patients due to their potential to worsen heart failure symptoms and increase hospitalization risk, as recommended by the American College of Cardiology and European Heart Society 1, 2
• The American College of Cardiology recommends against the use of NSAIDs in heart failure patients due to their mechanism of harm, which includes sodium and water retention, decreased renal blood flow, reduced glomerular filtration rate, and interference with the beneficial effects of ACE inhibitors and diuretics, with a Class III, Level B recommendation 2
• The American Heart Association and American College of Cardiology list calcium channel blockers as Class III (contraindicated) in the absence of coexistent angina or hypertension, due to their negative inotropic effects that can further depress myocardial function 1, 3
• Thiazolidinediones are contraindicated in heart failure patients due to their mechanism of harm, which includes causing fluid retention and edema, increasing the risk of heart failure exacerbation, with a Class III, Level A recommendation from the European Heart Society 2
• Most antiarrhythmic drugs (except amiodarone) are generally contraindicated in heart failure patients due to their proarrhythmic effects and negative inotropic properties, as stated by the American College of Cardiology and European Journal of Heart Failure 1, 4
• Long-term use of certain inotropic agents may increase mortality, according to the American College of Cardiology, except for short-term use for acute decompensation or as bridge to transplantation 3

Alternative Therapies

• For pain management, consider acetaminophen instead of NSAIDs, as recommended by the American College of Cardiology 1
• For hypertension, use ACE inhibitors, ARBs, or beta-blockers instead of calcium channel blockers, as recommended by the American Heart Association and American College of Cardiology 1
• For diabetes, use other antidiabetic medications instead of thiazolidinediones, as recommended by the European Heart Society 2

Medication Review and Patient Education

• Thoroughly review all medications in heart failure patients to identify contraindicated drugs, as recommended by the American College of Cardiology 1
• Ensure patients understand which OTC medications to avoid, including NSAIDs, as recommended by the American Heart Association and American College of Cardiology 1, 2