Drugs that worsen HF common in hospitalized HF

A new study published online in JACC Heart Failure reveals that several commonly prescribed medications that worsen heart failure (HF) are often continued or even initiated after an HF hospitalization.

A new study published online in JACC Heart Failure reveals that several commonly prescribed medications that worsen heart failure (HF) are often continued or even initiated after an HF hospitalization. Researchers examined the use of major drugs that aggravate HF both at hospital admission and at discharge in more than 500 older adults hospitalized for HF during more than 700 hospital admissions. Nearly one-half of the hospitalized patients received HF-aggravating medications either prior to admission or during hospitalization. Among patients taking these drugs, their use between admission and discharge decreased in only 17% of patients and increased in 12% of patients. Lead author Parag Goyal, MD, MSc, assistant professor of medicine, division of cardiology, and director of the HFpEF Program at Weill Cornell Medicine in New York City, notes that many medications that can worsen HF are actually first-line treatments for other comorbidities, such as ibuprofen for pain or albuterol for COPD. He observes, "We need more research to better understand the negative effects of these agents and how best to deal with these scenarios of 'therapeutic competition.'" The study found that at admission, the most common HF-exacerbating medications were albuterol, diltiazem, and NSAIDs, which are all Level B agents, as well as metformin, a Level C agent. The most common HF-aggravating drugs at discharge were albuterol, diltiazem, and metformin.