Congestive heart failure drugs to avoid: Difference between revisions

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{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}}; {{AE}} {{EdzelCo}}


==Overview==
==Overview==
Drugs like [[nonsteroidal anti-inflammatory drugs]], [[antiarrhythmic agents]], and [[calcium channel blockers]] should be avoided in patients with [[congestive heart failure]] as they are known to have negative or deleterious effects on cardiac contractility, the neurohormonal system, or may cause sodium retention.
[[Drugs]] like [[nonsteroidal anti-inflammatory drugs]], [[antiarrhythmic agents]], and [[calcium channel blockers]] should be avoided in [[patients]] with [[congestive heart failure]] as they are known to have negative or deleterious effects on [[cardiac]] [[contractility]], the [[neurohormonal]] [[system]], or may cause [[sodium retention]].


==Drugs to Be Avoided in Congestive Heart Failure==
==[[Drugs]] to Be Avoided in [[Congestive Heart Failure]]==
===Calcium Channel Blockers===
===[[Calcium Channel Blockers]]===
There is no direct role of [[calcium channel blockers]] in the management of [[CHF]]. Given that some agents have a [[negative inotropic]] effect, it has been hypothesized that [[calcium channel blockers]] might increase adverse outcomes among patients with [[CHF]] due to systolic dysfunction<ref name="pmid3552317">{{cite journal |author=Packer M, Kessler PD, Lee WH |title=Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far |journal=[[Circulation]] |volume=75 |issue=6 Pt 2 |pages=V56–64 |year=1987 |month=June |pmid=3552317 |doi= |url= |accessdate=2011-04-07}}</ref>. Vasoelective [[calcium channel blockers]] such as [[amlodipine]] and [[ felodipine]] have not been linked to adverse outcomes among patients with [[congestive heart failure]], but there is likewise no evidence of efficacy for these drugs in the management of [[CHF]].<ref name="pmid15215801">{{cite journal |author=Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA |title=Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT) |journal=[[American Heart Journal]] |volume=148 |issue=1 |pages=122–8 |year=2004 |month=July |pmid=15215801 |doi=10.1016/j.ahj.2003.12.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304001000 |accessdate=2011-04-07}}</ref> If a congestive heart failure patient has either [[angina]] or [[hypertension]] as a concomitant disease, [[amlodipine]] and [[felodipine]] appear to be safe for the treatment of these patients.
There is no direct role of [[calcium channel blockers]] in the management of [[CHF]]. Given that some agents (diltiazem and verapamil) have a [[negative inotropic]] effect, it has been hypothesized that [[calcium channel blockers]] might increase adverse outcomes among [[patients]] with [[CHF]] due to [[systolic dysfunction]]. <ref name="pmid3552317">{{cite journal |author=Packer M, Kessler PD, Lee WH |title=Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far |journal=[[Circulation]] |volume=75 |issue=6 Pt 2 |pages=V56–64 |year=1987 |month=June |pmid=3552317 |doi= |url= |accessdate=2011-04-07}}</ref>. [[Vasoselective]] [[calcium channel blockers]] such as [[amlodipine]] and [[ felodipine]] have not been linked to adverse outcomes among [[patients]] with [[congestive heart failure]], but there is likewise no evidence of [[efficacy]] for these [[drugs]] in the [[management]] of [[CHF]].<ref name="pmid15215801">{{cite journal |author=Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA |title=Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT) |journal=[[American Heart Journal]] |volume=148 |issue=1 |pages=122–8 |year=2004 |month=July |pmid=15215801 |doi=10.1016/j.ahj.2003.12.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304001000 |accessdate=2011-04-07}}</ref> If a [[congestive heart failure]] [[patient]] has either [[angina]] or [[hypertension]] as a concomitant [[disease]], [[amlodipine]] and [[felodipine]] appear to be safe for the [[treatment]] of these [[patients]].


===Antiarrhythmic Agents===
===[[Antiarrhythmic]] Agents===
Negative inotropic effect exerted by most [[antiarrhythmic]] drugs can precipitate CHF in patients with reduced LV function, and antiarrhythmic agents can also paradoxically be pro-arrhythmic.  The reduction in LV function can also reduce the elimination of these drugs leading to further drug toxicity. Other antiarrhythmic drugs can induce some proarrhythmic effect, especially class 1 agents and class 3 agents [[Ibutilide]] and [[sotalol]] (which has a negative inotropic effect);<ref name="pmid10486417">{{cite journal |author=Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ |title=Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group |journal=[[The New England Journal of Medicine]] |volume=341 |issue=12 |pages=857–65 |year=1999 |month=September |pmid=10486417 |doi=10.1056/NEJM199909163411201 |url=http://dx.doi.org/10.1056/NEJM199909163411201 |accessdate=2011-04-07}}</ref> the same class 3 agents in addition to [[dofetilide]] can induce [[torsades to pointes]].  [[Amiodarone]] is considered the safest of the antiarrhythmic drugs because of its minimal proarrhythmic effect and is generally the preferred drug for treating arrhythmias in CHF patients.[[Dronedarone]] should be avoided in patients who were hospitalized with CHF (this is a boxed warning). [[Disopyramide]] is contraindicated in patients with [[heart failure]]
Negative [[inotropic]] effect exerted by most [[antiarrhythmic]] [[drugs]] can precipitate [[CHF]] in [[patients]] with reduced [[LV function]], and [antiarrhythmic]] agents can also paradoxically be pro-[[arrhythmic]].  The reduction in [[LV function]] can also reduce the elimination of these [[drugs]] leading to further [[drug toxicity]]. Other [[antiarrhythmic drugs]] can induce some pro[[arrhythmic]] effect, especially class 1 agents and class 3 agents [[Ibutilide]] and [[sotalol]] (which has a negative inotropic effect);<ref name="pmid10486417">{{cite journal |author=Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ |title=Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group |journal=[[The New England Journal of Medicine]] |volume=341 |issue=12 |pages=857–65 |year=1999 |month=September |pmid=10486417 |doi=10.1056/NEJM199909163411201 |url=http://dx.doi.org/10.1056/NEJM199909163411201 |accessdate=2011-04-07}}</ref> the same class 3 agents in addition to [[dofetilide]] can induce [[torsades to pointes]].  [[Amiodarone]] is considered the safest of the [[antiarrhythmic]] drugs because of its minimal pro[[arrhythmic]] effect and is generally the preferred [[drug]] for treating [[arrhythmias]] in [[CHF]] [[patients]].[[Dronedarone]] should be avoided in [[patients]] who were [[hospitalized]] with [[CHF]] (this is a boxed warning). [[Disopyramide]] is contraindicated in [[patients]] with [[heart failure]].


===Nonsteroidal Anti-Inflammatory Drugs (NSAID)===
===[[Nonsteroidal Anti-Inflammatory Drugs]] ([[NSAID]])===
The administration of non-selective [[NSAIDs]] in [[CHF]] patients has been linked to:
The administration of non-selective [[NSAIDs]] in [[CHF]] [[patients]] has been linked to:
* An increased risk of [[CHF]] exacerbation
* An increased risk of [[CHF]] exacerbation
* A decline in [[renal function]]
* A decline in [[renal function]]
* Abnormal responses to both [[ACEIs]] and [[diuretics]]
* Abnormal responses to both [[ACEIs]] and [[diuretics]]
* Poorer survival in observational studies, particularly in the post [[MI]] period
* Poorer survival in [[observational studies]], particularly in the post [[MI]] period


===COX-2 selective inhibitors===
===[[COX-2 selective inhibitors]]===
Observational data suggest that these agents may be linked with an increase in [[congestive heart failure]] exacerbations as well as an increased mortality.<ref name="pmid9605782">{{cite journal |author=Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A |title=NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics |journal=[[Archives of Internal Medicine]] |volume=158 |issue=10 |pages=1108–12 |year=1998 |month=May |pmid=9605782 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9605782 |accessdate=2011-04-08}}</ref>
[[Observational data]] suggest that these agents may be linked with an increase in [[congestive heart failure]] exacerbations as well as an increased [[mortality]].<ref name="pmid9605782">{{cite journal |author=Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A |title=NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics |journal=[[Archives of Internal Medicine]] |volume=158 |issue=10 |pages=1108–12 |year=1998 |month=May |pmid=9605782 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9605782 |accessdate=2011-04-08}}</ref>


===Aspirin===
===[[Aspirin]]===
[[Aspirin]] is often prescribed as primary prevention in patients with risk factors for cardiovascular disease or as secondary prevention in patients with established cardiovascular disease.  However, among patients with congestive heart failure, the risks and benefits of aspirin are not as well established. Concern has arisen regarding the potential interaction between aspirin with [[ACEIs]] and [[beta blockers]].  At this time the American College of Chest Physicians guidelines indicate that it is reasonable to withhold [[aspirin]] among patients who have non-ischemic [[heart failure]], while it may be reasonable to continue [[aspirin]] among those patients who have ischemic [[heart failure]].
[[Aspirin]] is often prescribed as [[primary prevention]] in [[patients]] with risk factors for [[cardiovascular disease]] or as [[secondary prevention]] in [[patients]] with established [[cardiovascular disease]].  However, among [[patients]] with [[congestive heart failure]], the risks and benefits of [[aspirin]] are not as well established. Concern has arisen regarding the potential interaction between [[aspirin]] with [[ACEIs]] and [[beta blockers]].  At this time the American College of Chest Physicians guidelines indicate that it is reasonable to withhold [[aspirin]] among patients who have [[non-ischemic]] [[heart failure]], while it may be reasonable to continue [[aspirin]] among those [[patients]] who have [[ischemic]] [[heart failure]].
:*[[Angiotensin-Converting Enzyme Inhibitors]]
:*[[Angiotensin-Converting Enzyme Inhibitors]]
:Although there is some data to suggest that aspirin may attenuate some of the hemodynamic benefits of [[ACE inhibitors]], there is no data indicating that the beneficial clinical outcomes associated with [[ACE inhibitors]] is reduced.
:Although there is some data to suggest that [[aspirin]] may attenuate some of the [[hemodynamic]] benefits of [[ACE inhibitors]], there is no data indicating that the beneficial clinical outcomes associated with [[ACE inhibitors]] is reduced.


:*[[Beta Blockers]]
:*[[Beta Blockers]]
:There is likewise some data to suggest that [[aspirin]] may attenuate the benefit of [[beta blockers]] on the [[left ventricular ejection fraction]] among patients with [[congestive heart failure]].
:There is likewise some data to suggest that [[aspirin]] may attenuate the benefit of [[beta blockers]] on the [[left ventricular ejection fraction]] among patients with [[congestive heart failure]].


===Oral Hypoglycemic Agents===
===[[Oral Hypoglycemic Agents]]===
:*[[Metformin]]
:*[[Metformin]]
:[[Metformin]] is associated with [[lactic acidosis]], which can be fatal in patients with CHF.<ref name="pmid1444694">{{cite journal |author=Gan SC, Barr J, Arieff AI, Pearl RG |title=Biguanide-associated lactic acidosis. Case report and review of the literature |journal=[[Archives of Internal Medicine]] |volume=152 |issue=11 |pages=2333–6 |year=1992 |month=November |pmid=1444694 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=1444694 |accessdate=2011-04-08}}</ref>
:[[Metformin]] is associated with [[lactic acidosis]], which can be fatal in [[patients]] with [[CHF]].<ref name="pmid1444694">{{cite journal |author=Gan SC, Barr J, Arieff AI, Pearl RG |title=Biguanide-associated [[lactic acidosis]]. [[Case report]] and review of the literature |journal=[[Archives of Internal Medicine]] |volume=152 |issue=11 |pages=2333–6 |year=1992 |month=November |pmid=1444694 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=1444694 |accessdate=2011-04-08}}</ref>


:*[[Thiazolidinediones]]
:*[[Thiazolidinediones]]
:Administration of [[thiazolidinediones]] is associated with fluid retention which may in turn cause volume overload and worsening of patients with CHF.<ref name="pmid15699279">{{cite journal |author=Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM |title=Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study |journal=[[Circulation]] |volume=111 |issue=5 |pages=583–90 |year=2005 |month=February |pmid=15699279 |doi=10.1161/01.CIR.0000154542.13412.B1 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15699279 |accessdate=2011-04-08}}</ref>
:Administration of [[thiazolidinediones]] is associated with [[fluid retention]] which may in turn cause [[volume overload]] and worsening of [[patients]] with [[CHF]].<ref name="pmid15699279">{{cite journal |author=Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM |title=Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study |journal=[[Circulation]] |volume=111 |issue=5 |pages=583–90 |year=2005 |month=February |pmid=15699279 |doi=10.1161/01.CIR.0000154542.13412.B1 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15699279 |accessdate=2011-04-08}}</ref>


===Antidepressants===
===[[Antidepressants]]===
[[Depression]] among patients with congestive heart failure is associated with poorer clinical outcomes including higher mortality <ref name="pmid17249635">{{cite journal |author=Swenson JR, Doucette S, Fergusson D |title=Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials |journal=[[Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie]] |volume=51 |issue=14 |pages=923–9 |year=2006 |month=December |pmid=17249635 |doi= |url= |accessdate=2011-04-08}}</ref> Questions have been raised as to whether it is the depression itself that directly harms congestive heart failure patients or whether the harm is mediated by treatment with drugs such as [[tricyclic antidepressants]]. It appears that it is the depression itself and not the drugs used to treat depression that is independently associated with worse clinical outcomes.  There is no difference in the risk of adverse outcomes among [[heart failure]] patients treated with either [[tricyclic antidepressants]] or [[selective serotonin reuptake inhibitors]] ([[SSRI]]s).
[[Depression]] among [[patients]] with [[congestive heart failure]] is associated with poorer clinical outcomes including higher [[mortality]].<ref name="pmid17249635">{{cite journal |author=Swenson JR, Doucette S, Fergusson D |title=Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials |journal=[[Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie]] |volume=51 |issue=14 |pages=923–9 |year=2006 |month=December |pmid=17249635 |doi= |url= |accessdate=2011-04-08}}</ref> Questions have been raised as to whether it is[[ the depression]] itself that directly [[harm]]s [[congestive heart failure]] [[patients]] or whether the [[harm]] is mediated by [[treatment]] with [[drugs]] such as [[tricyclic antidepressants]]. It appears that it is the [[depression]] itself and not the [[drugs]] used to treat [[depression]] that is independently associated with worse [[clinical outcomes]].  There is no difference in the risk of [[adverse outcomes]] among [[heart failure]] [[patients]] treated with either [[tricyclic antidepressants]] or [[selective serotonin reuptake inhibitors]] ([[SSRI]]s).


===Phosphodiesterase inhibitors '''PDE'''===
===[[Phosphodiesterase inhibitors]] '''[[PDE]]'''===
*The [[PDE-3 inhibitors]] such as<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2011-04-08}}</ref> [[Cilostazol]] and the PDE-4 inibitor <ref name="pmid11159509">{{cite journal |author=Storen EC, Tefferi A |title=Long-term use of anagrelide in young patients with essential thrombocythemia |journal=[[Blood]] |volume=97 |issue=4 |pages=863–6 |year=2001 |month=February |pmid=11159509 |doi= |url=http://www.bloodjournal.org/cgi/pmidlookup?view=long&pmid=11159509 |accessdate=2011-04-08}}</ref> [[Anagrelide]] should be avoided in patients with CHF, because of an increase risk of [[high-output heart failure]] and fluid retention that is associated with those drugs.<ref name="pmid1731512">{{cite journal |author= |title=Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group |journal=[[The American Journal of Medicine]] |volume=92 |issue=1 |pages=69–76 |year=1992 |month=January |pmid=1731512 |doi= |url= |accessdate=2011-04-08}}</ref>
*The [[PDE-3 inhibitors]] such as<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2011-04-08}}</ref> [[Cilostazol]] and the PDE-4 inibitor <ref name="pmid11159509">{{cite journal |author=Storen EC, Tefferi A |title=Long-term use of anagrelide in young patients with essential thrombocythemia |journal=[[Blood]] |volume=97 |issue=4 |pages=863–6 |year=2001 |month=February |pmid=11159509 |doi= |url=http://www.bloodjournal.org/cgi/pmidlookup?view=long&pmid=11159509 |accessdate=2011-04-08}}</ref> [[Anagrelide]] should be avoided in patients with CHF, because of an increase risk of [[high-output heart failure]] and fluid retention that is associated with those drugs.<ref name="pmid1731512">{{cite journal |author= |title=Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group |journal=[[The American Journal of Medicine]] |volume=92 |issue=1 |pages=69–76 |year=1992 |month=January |pmid=1731512 |doi= |url= |accessdate=2011-04-08}}</ref>


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===Chemotherapy===
===Chemotherapy===
Cardiotoxic chemotherapeutic agents as [[Cyclophosphamide]], [[Trastuzumab]], [[Bevacizumab]] and [[Anthracyclines]], should be avoided in CHF patients <ref name="pmid11248153">{{cite journal |author=Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L |title=Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2 |journal=[[The New England Journal of Medicine]] |volume=344 |issue=11 |pages=783–92 |year=2001 |month=March |pmid=11248153 |doi=10.1056/NEJM200103153441101 |url=http://dx.doi.org/10.1056/NEJM200103153441101 |accessdate=2011-04-08}}</ref>
[[Cardiotoxic]] [[chemotherapeutic agents]] as [[Cyclophosphamide]], [[Trastuzumab]], [[Bevacizumab]] and [[Anthracyclines]], should be avoided in [[CHF]] [[patients]]. <ref name="pmid11248153">{{cite journal |author=Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L |title=Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2 |journal=[[The New England Journal of Medicine]] |volume=344 |issue=11 |pages=783–92 |year=2001 |month=March |pmid=11248153 |doi=10.1056/NEJM200103153441101 |url=http://dx.doi.org/10.1056/NEJM200103153441101 |accessdate=2011-04-08}}</ref>


===Tumor Necrosis Factor alpha inhibitors (TNF-alpha)===
===Tumor Necrosis Factor alpha inhibitors (TNF-alpha)===
New onset or worsening of pre-existing heart failure have been linked to TNF-alpha inhibitors.<ref name="pmid12796126">{{cite journal |author=Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT |title=Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial |journal=[[Circulation]] |volume=107 |issue=25 |pages=3133–40 |year=2003 |month=July |pmid=12796126 |doi=10.1161/01.CIR.0000077913.60364.D2 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12796126 |accessdate=2011-04-08}}</ref> [[Infliximab]] has been specifically contraindicated in doses over 5mg/kg in patients with heart failure.
New onset or worsening of pre-existing [[heart failure]] have been linked to [[TNF-alpha inhibitors]].<ref name="pmid12796126">{{cite journal |author=Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT |title=Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial |journal=[[Circulation]] |volume=107 |issue=25 |pages=3133–40 |year=2003 |month=July |pmid=12796126 |doi=10.1161/01.CIR.0000077913.60364.D2 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12796126 |accessdate=2011-04-08}}</ref> [[Infliximab]] has been specifically contraindicated in doses over 5mg/kg in patients with heart failure.


===Antihistamines===
===Antihistamines===
Some second generation antihistamines as [[terfenadine]] and [[astemizole]] have been reported to cause [[long QT syndrome]] and should not be used in CHF patients.<ref name="pmid14594906">{{cite journal |author=Yap YG, Camm AJ |title=Drug induced QT prolongation and torsades de pointes |journal=[[Heart (British Cardiac Society)]] |volume=89 |issue=11 |pages=1363–72 |year=2003 |month=November |pmid=14594906 |pmc=1767957 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=14594906 |accessdate=2011-04-08}}</ref>  
Some second generation [[antihistamines]] as [[terfenadine]] and [[astemizole]] have been reported to cause [[long QT syndrome]] and should not be used in [[CHF]] [[patients]].<ref name="pmid14594906">{{cite journal |author=Yap YG, Camm AJ |title=Drug induced QT prolongation and torsades de pointes |journal=[[Heart (British Cardiac Society)]] |volume=89 |issue=11 |pages=1363–72 |year=2003 |month=November |pmid=14594906 |pmc=1767957 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=14594906 |accessdate=2011-04-08}}</ref>


===Serum Potassium===
===[[Serum]] [[Potassium]]===
Serum [[potassium]] should be closely monitored in CHF patients, in order of preventing either [[hypokalemia]] or [[hyperkalemia]], which could greatly affect cardiac excitability and conduction, leading to [[sudden cardiac death]].<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>
[[Serum]] [[potassium]] should be closely monitored in [[CHF]] [[patients]], in order of preventing either [[hypokalemia]] or [[hyperkalemia]], which could greatly affect [[cardiac]] [[excitability]] and [[conduction]], leading to [[sudden cardiac death]].<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>
Serum [[potassium]] should be maintained between 4.0 to 5.0 mEq per liter range, because low potassium level may affect [[digitalis]] and antiarrhythmic drugs treatment, while high potassium level can prevent the use of treatments known to prolong life.<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>
Serum [[potassium]] should be maintained between 4.0 to 5.0 mEq per liter range, because low [[potassium]] level may affect [[digitalis]] and [[antiarrhythmic]] [[drugs]] [[treatment]], while high [[potassium]] level can prevent the use of [[treatments]] known to prolong [[life]].<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new [[physiologic]] approach to control of [[arrhythmia]] |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>


Supervision of CHF patients with close monitoring of treatment and diet is a very important aspect of the follow-up process in those individuals. Body weight and medications should be closely monitored, because any minor change in those parameters can have a significant effect over symptoms and hospitalization of patients with CHF.<ref name="pmid7565975">{{cite journal |author=Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM |title=A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure |journal=[[The New England Journal of Medicine]] |volume=333 |issue=18 |pages=1190–5 |year=1995 |month=November |pmid=7565975 |doi=10.1056/NEJM199511023331806 |url=http://dx.doi.org/10.1056/NEJM199511023331806 |accessdate=2011-04-10}}</ref> Patient education is a crucial aspect of the management of CHF, patient and family surveillance over any new change of symptoms or body weight is important in allowing early detection of those changes and implementing new treatment strategies to reduce further complications.<ref name="pmid10051785">{{cite journal |author=Philbin EF |title=Comprehensive multidisciplinary programs for the management of patients with congestive heart failure |journal=[[Journal of General Internal Medicine]] |volume=14 |issue=2 |pages=130–5 |year=1999 |month=February |pmid=10051785 |doi= |url= |accessdate=2011-04-10}}</ref>
Supervision of [[CHF]] [[patients]] with close monitoring of [[treatment]] and [[diet]] is a very important aspect of the follow-up process in those individuals. [[Body]] [[weight]] and [[medications]] should be closely monitored, because any minor change in those parameters can have a significant effect over [[symptoms]] and [[hospitalization]] of [[patients]] with [[CHF]].<ref name="pmid7565975">{{cite journal |author=Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM |title=A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure |journal=[[The New England Journal of Medicine]] |volume=333 |issue=18 |pages=1190–5 |year=1995 |month=November |pmid=7565975 |doi=10.1056/NEJM199511023331806 |url=http://dx.doi.org/10.1056/NEJM199511023331806 |accessdate=2011-04-10}}</ref> [[Patient]] education is a crucial aspect of the [[management]] of [[CHF]], [[patient]] and [[family]] surveillance over any new change of [[symptoms]] or [[body weight]] is important in allowing early detection of those changes and implementing new [[treatment]] strategies to reduce further [[complications]].<ref name="pmid10051785">{{cite journal |author=Philbin EF |title=Comprehensive multidisciplinary programs for the management of patients with congestive heart failure |journal=[[Journal of General Internal Medicine]] |volume=14 |issue=2 |pages=130–5 |year=1999 |month=February |pmid=10051785 |doi= |url= |accessdate=2011-04-10}}</ref>


===Theophyline===
===[[Theophyline]]===
Decompensation of [[congestive heart failure]] can be associated with [[theophylline]] toxicity, even at normal theophylline levels. If [[theophylline]] must be administered, the dosing should be reduced in the heart failure patient.
Decompensation of [[congestive heart failure]] can be associated with [[theophylline]] [[toxicity]], even at normal [[theophylline]] levels. If [[theophylline]] must be administered, the [[dosing]] should be reduced in the [[heart failure]] [[patient]].


==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
==2022 AHA/ACC/ HFSA Heart Failure Guideline (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref>==


===Antiarrhythmics in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
====[[Drugs]] of Unproven Value or That May Worsen [[HF]]====


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]], [[dihydropiridine calcium  channel-blocking  drugs]] are not recommended [[treatment]] for [[HF]].<ref name="pmid8813041">{{cite journal| author=Packer M, O'Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN | display-authors=etal| title=Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 15 | pages= 1107-14 | pmid=8813041 | doi=10.1056/NEJM199610103351504 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813041  }} </ref><ref name="pmid24621933">{{cite journal| author=Packer M, Carson P, Elkayam U, Konstam MA, Moe G, O'Connor C | display-authors=etal| title=Effect of amlodipine on the survival of patients with severe chronic heart failure due to a nonischemic cardiomyopathy: results of the PRAISE-2 study (prospective randomized amlodipine survival evaluation 2). | journal=JACC Heart Fail | year= 2013 | volume= 1 | issue= 4 | pages= 308-314 | pmid=24621933 | doi=10.1016/j.jchf.2013.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24621933  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Drugs known to adversely affect the clinical status of patients with current or prior symptoms of [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]) should be avoided or withdrawn whenever possible (e.g., [[NSAID|nonsteroidal anti-inflammatory drugs]], most [[Antiarrhythmic agent|antiarrhythmic drugs]], and most [[Calcium channel blocker|calcium channel blocking drugs]].<ref name="pmid9605782">{{cite journal |author=Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A |title=NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics |journal=[[Archives of Internal Medicine]] |volume=158 |issue=10 |pages=1108–12 |year=1998 |month=May |pmid=9605782 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9605782 |accessdate=2012-04-05}}</ref><ref name="pmid2703968">{{cite journal |author=Herchuelz A, Derenne F, Deger F, Juvent M, Van Ganse E, Staroukine M, Verniory A, Boeynaems JM, Douchamps J |title=Interaction between nonsteroidal anti-inflammatory drugs and loop diuretics: modulation by sodium balance |journal=[[The Journal of Pharmacology and Experimental Therapeutics]] |volume=248 |issue=3 |pages=1175–81 |year=1989 |month=March |pmid=2703968 |doi= |url=http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=2703968 |accessdate=2012-04-05}}</ref><ref name="pmid1529943">{{cite journal |author=Gottlieb SS, Robinson S, Krichten CM, Fisher ML |title=Renal response to indomethacin in congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy |journal=[[The American Journal of Cardiology]] |volume=70 |issue=9 |pages=890–3 |year=1992 |month=October |pmid=1529943 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(92)90733-F |accessdate=2012-04-05}}</ref><ref name="pmid1655327">{{cite journal |author=Bank AJ, Kubo SH, Rector TS, Heifetz SM, Williams RE |title=Local forearm vasodilation with intra-arterial administration of enalaprilat in humans |journal=[[Clinical Pharmacology and Therapeutics]] |volume=50 |issue=3 |pages=314–21 |year=1991 |month=September |pmid=1655327 |doi= |url= |accessdate=2012-04-05}}</ref><ref name="pmid2473403">{{cite journal |author= |title=Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators |journal=[[The New England Journal of Medicine]] |volume=321 |issue=6 |pages=406–12 |year=1989 |month=August |pmid=2473403 |doi=10.1056/NEJM198908103210629 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198908103210629?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-05}}</ref><ref name="pmid1377359">{{cite journal |author= |title=Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. The Cardiac Arrhythmia Suppression Trial II Investigators |journal=[[The New England Journal of Medicine]] |volume=327 |issue=4 |pages=227–33 |year=1992 |month=July |pmid=1377359 |doi=10.1056/NEJM199207233270403 |url=http://dx.doi.org/10.1056/NEJM199207233270403 |accessdate=2012-04-05}}</ref><ref name="pmid2476016">{{cite journal |author=Pratt CM, Eaton T, Francis M, Woolbert S, Mahmarian J, Roberts R, Young JB |title=The inverse relationship between baseline left ventricular ejection fraction and outcome of antiarrhythmic therapy: a dangerous imbalance in the risk-benefit ratio |journal=[[American Heart Journal]] |volume=118 |issue=3 |pages=433–40 |year=1989 |month=September |pmid=2476016 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-8703(89)90254-8 |accessdate=2012-04-05}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]], [[vitamins]], [[nutritional supplements]], and [[hormonal therapy]] are not recommended other than to correct specific deficiencies. <ref name="pmid31709816">{{cite journal| author=Djoussé L, Cook NR, Kim E, Bodar V, Walter J, Bubes V | display-authors=etal| title=Supplementation With Vitamin D and Omega-3 Fatty Acids and Incidence of Heart Failure Hospitalization: VITAL-Heart Failure. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= 784-786 | pmid=31709816 | doi=10.1161/CIRCULATIONAHA.119.044645 | pmc=7054158 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31709816  }} </ref><ref name="pmid31032644">{{cite journal| author=Wang T, Liu Z, Fu J, Min Z| title=Meta-analysis of vitamin D supplementation in the treatment of chronic heart failure. | journal=Scand Cardiovasc J | year= 2019 | volume= 53 | issue= 3 | pages= 110-116 | pmid=31032644 | doi=10.1080/14017431.2019.1612084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31032644  }} </ref><ref name="pmid30654912">{{cite journal| author=Zittermann A, Ernst JB, Prokop S, Fuchs U, Gruszka A, Dreier J | display-authors=etal| title=Vitamin D supplementation of 4000 IU daily and cardiac function in patients with advanced heart failure: The EVITA trial. | journal=Int J Cardiol | year= 2019 | volume= 280 | issue= | pages= 117-123 | pmid=30654912 | doi=10.1016/j.ijcard.2019.01.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30654912  }} </ref><ref name="pmid15769967">{{cite journal| author=Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM | display-authors=etal| title=Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. | journal=JAMA | year= 2005 | volume= 293 | issue= 11 | pages= 1338-47 | pmid=15769967 | doi=10.1001/jama.293.11.1338 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15769967  }} </ref><ref name="pmid16645413">{{cite journal| author=Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L | display-authors=etal| title=Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial. | journal=J Cardiovasc Med (Hagerstown) | year= 2006 | volume= 7 | issue= 5 | pages= 347-50 | pmid=16645413 | doi=10.2459/01.JCM.0000223257.09062.17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16645413  }} </ref><ref name="pmid25282031">{{cite journal| author=Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D | display-authors=etal| title=The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. | journal=JACC Heart Fail | year= 2014 | volume= 2 | issue= 6 | pages= 641-9 | pmid=25282031 | doi=10.1016/j.jchf.2014.06.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25282031  }} </ref><ref name="pmid24049047">{{cite journal| author=Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A | display-authors=etal| title=Coenzyme Q10 for heart failure. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 6 | pages= CD008684 | pmid=24049047 | doi=10.1002/14651858.CD008684.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24049047  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[HFrEF]], [[non-dihydropiridine calcium channel-blocking drugs]] are not recommended. <ref name="pmid2220572">{{cite journal| author=| title=Effect of verapamil on mortality and major events after acute myocardial infarction (the Danish Verapamil Infarction Trial II--DAVIT II) | journal=Am J Cardiol | year= 1990 | volume= 66 | issue= 10 | pages= 779-85 | pmid=2220572 | doi=10.1016/0002-9149(90)90351-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220572  }} </ref><ref name="pmid2899840">{{cite journal| author=Multicenter Diltiazem Postinfarction Trial Research Group| title=The effect of diltiazem on mortality and reinfarction after myocardial infarction. | journal=N Engl J Med | year= 1988 | volume= 319 | issue= 7 | pages= 385-92 | pmid=2899840 | doi=10.1056/NEJM198808183190701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2899840  }} </ref><ref name="pmid1984898">{{cite journal| author=Goldstein RE, Boccuzzi SJ, Cruess D, Nattel S| title=Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. | journal=Circulation | year= 1991 | volume= 83 | issue= 1 | pages= 52-60 | pmid=1984898 | doi=10.1161/01.cir.83.1.52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1984898  }} </ref><ref name="pmid8759075">{{cite journal| author=Figulla HR, Gietzen F, Zeymer U, Raiber M, Hegselmann J, Soballa R | display-authors=etal| title=Diltiazem improves cardiac function and exercise capacity in patients with idiopathic dilated cardiomyopathy. Results of the Diltiazem in Dilated Cardiomyopathy Trial. | journal=Circulation | year= 1996 | volume= 94 | issue= 3 | pages= 346-52 | pmid=8759075 | doi=10.1161/01.cir.94.3.346 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8759075  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.'''In [[patients]] with [[HFrEF]], class IC [[antiarrhythmic]] [[medications]] and [[dronedarone]] may increase the risk of [[mortality]]. <ref name="pmid1900101">{{cite journal| author=Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH | display-authors=etal| title=Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 12 | pages= 781-8 | pmid=1900101 | doi=10.1056/NEJM199103213241201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1900101  }} </ref><ref name="pmid8691967">{{cite journal| author=Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF | display-authors=etal| title=Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol. | journal=Lancet | year= 1996 | volume= 348 | issue= 9019 | pages= 7-12 | pmid=8691967 | doi=10.1016/s0140-6736(96)02149-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8691967  }} </ref><ref name="pmid18565860">{{cite journal| author=Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Lévy S, Crijns H | display-authors=etal| title=Increased mortality after dronedarone therapy for severe heart failure. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 25 | pages= 2678-87 | pmid=18565860 | doi=10.1056/NEJMoa0800456 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18565860  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''5.'''In [[patients]] with [[HFrEF]], [[thiazolidinediones]] increase the risk of worsening [[HF]] [[symptoms]] and [[hospitalizations]]. <ref name="pmid18073359">{{cite journal| author=Lipscombe LL, Gomes T, Lévesque LE, Hux JE, Juurlink DN, Alter DA| title=Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. | journal=JAMA | year= 2007 | volume= 298 | issue= 22 | pages= 2634-43 | pmid=18073359 | doi=10.1001/jama.298.22.2634 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18073359  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18588264 Review in: ACP J Club. 2008 Jun 17;148(4):13] </ref><ref name="pmid17905165">{{cite journal| author=Lago RM, Singh PP, Nesto RW| title=Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. | journal=Lancet | year= 2007 | volume= 370 | issue= 9593 | pages= 1129-36 | pmid=17905165 | doi=10.1016/S0140-6736(07)61514-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17905165  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18311869 Review in: ACP J Club. 2008 Mar-Apr;148(2):39] </ref><ref name="pmid17448371">{{cite journal| author=Dargie HJ, Hildebrandt PR, Riegger GA, McMurray JJ, McMorn SO, Roberts JN | display-authors=etal| title=A randomized, placebo-controlled trial assessing the effects of rosiglitazone on echocardiographic function and cardiac status in type 2 diabetic patients with New York Heart Association Functional Class I or II Heart Failure. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 16 | pages= 1696-704 | pmid=17448371 | doi=10.1016/j.jacc.2006.10.077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17448371  }} </ref><ref name="pmid19501900">{{cite journal| author=Home PD, Pocock SJ, Beck-Nielsen H, Curtis PS, Gomis R, Hanefeld M | display-authors=etal| title=Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. | journal=Lancet | year= 2009 | volume= 373 | issue= 9681 | pages= 2125-35 | pmid=19501900 | doi=10.1016/S0140-6736(09)60953-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19501900  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19841445 Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-8]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19949171 Review in: Evid Based Med. 2009 Dec;14(6):168] </ref><ref name="pmid18672190">{{cite journal| author=Giles TD, Miller AB, Elkayam U, Bhattacharya M, Perez A| title=Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction. | journal=J Card Fail | year= 2008 | volume= 14 | issue= 6 | pages= 445-52 | pmid=18672190 | doi=10.1016/j.cardfail.2008.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18672190  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|-[[
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''6.'''In [[patients]] with [[type 2 diabetes]] and high [[cardiovascular]] risk, the [[dipeptidyl peptidase-4]] ([[DPP-4]]) inhibitors [[saxagliptin]] and [[alogliptin]] increase the risk of [[HF]] [[hospitalization]] and should be avoided in [[patients]] with [[HF]]. <ref name="pmid25189213">{{cite journal| author=Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P | display-authors=etal| title=Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. | journal=Circulation | year= 2014 | volume= 130 | issue= 18 | pages= 1579-88 | pmid=25189213 | doi=10.1161/CIRCULATIONAHA.114.010389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25189213  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25894044 Review in: Ann Intern Med. 2015 Apr 21;162(8):JC11] </ref><ref name="pmid25765696">{{cite journal| author=Zannad F, Cannon CP, Cushman WC, Bakris GL, Menon V, Perez AT | display-authors=etal| title=Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9982 | pages= 2067-76 | pmid=25765696 | doi=10.1016/S0140-6736(14)62225-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25765696  }} </ref><ref name="pmid28459046">{{cite journal| author=Verma S, Goldenberg RM, Bhatt DL, Farkouh ME, Quan A, Teoh H | display-authors=etal| title=Dipeptidyl peptidase-4 inhibitors and the risk of heart failure: a systematic review and meta-analysis. | journal=CMAJ Open | year= 2017 | volume= 5 | issue= 1 | pages= E152-E177 | pmid=28459046 | doi=10.9778/cmajo.20160058 | pmc=5403656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28459046  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''7.'''In [[patients]] with [[HFrEF]], [[NSAIDs]] worsen [[HF]] [[symptoms]] and should be avoided or withdrawn whenever possible. <ref name="pmid15172772">{{cite journal| author=Mamdani M, Juurlink DN, Lee DS, Rochon PA, Kopp A, Naglie G | display-authors=etal| title=Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. | journal=Lancet | year= 2004 | volume= 363 | issue= 9423 | pages= 1751-6 | pmid=15172772 | doi=10.1016/S0140-6736(04)16299-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15172772  }} </ref><ref name="pmid15947399">{{cite journal| author=Hudson M, Richard H, Pilote L| title=Differences in outcomes of patients with congestive heart failure prescribed celecoxib, rofecoxib, or non-steroidal anti-inflammatory drugs: population based study. | journal=BMJ | year= 2005 | volume= 330 | issue= 7504 | pages= 1370 | pmid=15947399 | doi=10.1136/bmj.330.7504.1370 | pmc=558290 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15947399  }} </ref><ref name="pmid19171810">{{cite journal| author=Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Fosbøl EL | display-authors=etal| title=Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. | journal=Arch Intern Med | year= 2009 | volume= 169 | issue= 2 | pages= 141-9 | pmid=19171810 | doi=10.1001/archinternmed.2008.525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19171810  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19528557 Review in: Ann Intern Med. 2009 Jun 16;150(12):JC6-12] </ref><ref name="pmid11822918">{{cite journal| author=Feenstra J, Heerdink ER, Grobbee DE, Stricker BH| title=Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study. | journal=Arch Intern Med | year= 2002 | volume= 162 | issue= 3 | pages= 265-70 | pmid=11822918 | doi=10.1001/archinte.162.3.265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11822918  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}
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==References==
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Latest revision as of 21:55, 22 June 2022
Resident
Survival
Guide
File:Critical Pathways.gif

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure drugs to avoid On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure drugs to avoid

CDC on Congestive heart failure drugs to avoid

Congestive heart failure drugs to avoid in the news

Blogs on Congestive heart failure drugs to avoid

Directions to Hospitals Treating Congestive heart failure drugs to avoid

Risk calculators and risk factors for Congestive heart failure drugs to avoid

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]

Overview

Drugs like nonsteroidal anti-inflammatory drugs, antiarrhythmic agents, and calcium channel blockers should be avoided in patients with congestive heart failure as they are known to have negative or deleterious effects on cardiac contractility, the neurohormonal system, or may cause sodium retention.

Drugs to Be Avoided in Congestive Heart Failure

Calcium Channel Blockers

There is no direct role of calcium channel blockers in the management of CHF. Given that some agents (diltiazem and verapamil) have a negative inotropic effect, it has been hypothesized that calcium channel blockers might increase adverse outcomes among patients with CHF due to systolic dysfunction. [1]. Vasoselective calcium channel blockers such as amlodipine and felodipine have not been linked to adverse outcomes among patients with congestive heart failure, but there is likewise no evidence of efficacy for these drugs in the management of CHF.[2] If a congestive heart failure patient has either angina or hypertension as a concomitant disease, amlodipine and felodipine appear to be safe for the treatment of these patients.

Antiarrhythmic Agents

Negative inotropic effect exerted by most antiarrhythmic drugs can precipitate CHF in patients with reduced LV function, and [antiarrhythmic]] agents can also paradoxically be pro-arrhythmic. The reduction in LV function can also reduce the elimination of these drugs leading to further drug toxicity. Other antiarrhythmic drugs can induce some proarrhythmic effect, especially class 1 agents and class 3 agents Ibutilide and sotalol (which has a negative inotropic effect);[3] the same class 3 agents in addition to dofetilide can induce torsades to pointes. Amiodarone is considered the safest of the antiarrhythmic drugs because of its minimal proarrhythmic effect and is generally the preferred drug for treating arrhythmias in CHF patients.Dronedarone should be avoided in patients who were hospitalized with CHF (this is a boxed warning). Disopyramide is contraindicated in patients with heart failure.

Nonsteroidal Anti-Inflammatory Drugs (NSAID)

The administration of non-selective NSAIDs in CHF patients has been linked to:

COX-2 selective inhibitors

Observational data suggest that these agents may be linked with an increase in congestive heart failure exacerbations as well as an increased mortality.[4]

Aspirin

Aspirin is often prescribed as primary prevention in patients with risk factors for cardiovascular disease or as secondary prevention in patients with established cardiovascular disease. However, among patients with congestive heart failure, the risks and benefits of aspirin are not as well established. Concern has arisen regarding the potential interaction between aspirin with ACEIs and beta blockers. At this time the American College of Chest Physicians guidelines indicate that it is reasonable to withhold aspirin among patients who have non-ischemic heart failure, while it may be reasonable to continue aspirin among those patients who have ischemic heart failure.

Although there is some data to suggest that aspirin may attenuate some of the hemodynamic benefits of ACE inhibitors, there is no data indicating that the beneficial clinical outcomes associated with ACE inhibitors is reduced.
There is likewise some data to suggest that aspirin may attenuate the benefit of beta blockers on the left ventricular ejection fraction among patients with congestive heart failure.

Oral Hypoglycemic Agents

Metformin is associated with lactic acidosis, which can be fatal in patients with CHF.[5]
Administration of thiazolidinediones is associated with fluid retention which may in turn cause volume overload and worsening of patients with CHF.[6]

Antidepressants

Depression among patients with congestive heart failure is associated with poorer clinical outcomes including higher mortality.[7] Questions have been raised as to whether it isthe depression itself that directly harms congestive heart failure patients or whether the harm is mediated by treatment with drugs such as tricyclic antidepressants. It appears that it is the depression itself and not the drugs used to treat depression that is independently associated with worse clinical outcomes. There is no difference in the risk of adverse outcomes among heart failure patients treated with either tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs).

Phosphodiesterase inhibitors PDE

Chemotherapy

Cardiotoxic chemotherapeutic agents as Cyclophosphamide, Trastuzumab, Bevacizumab and Anthracyclines, should be avoided in CHF patients. [12]

Tumor Necrosis Factor alpha inhibitors (TNF-alpha)

New onset or worsening of pre-existing heart failure have been linked to TNF-alpha inhibitors.[13] Infliximab has been specifically contraindicated in doses over 5mg/kg in patients with heart failure.

Antihistamines

Some second generation antihistamines as terfenadine and astemizole have been reported to cause long QT syndrome and should not be used in CHF patients.[14]

Serum Potassium

Serum potassium should be closely monitored in CHF patients, in order of preventing either hypokalemia or hyperkalemia, which could greatly affect cardiac excitability and conduction, leading to sudden cardiac death.[15] Serum potassium should be maintained between 4.0 to 5.0 mEq per liter range, because low potassium level may affect digitalis and antiarrhythmic drugs treatment, while high potassium level can prevent the use of treatments known to prolong life.[15]

Supervision of CHF patients with close monitoring of treatment and diet is a very important aspect of the follow-up process in those individuals. Body weight and medications should be closely monitored, because any minor change in those parameters can have a significant effect over symptoms and hospitalization of patients with CHF.[16] Patient education is a crucial aspect of the management of CHF, patient and family surveillance over any new change of symptoms or body weight is important in allowing early detection of those changes and implementing new treatment strategies to reduce further complications.[17]

Theophyline

Decompensation of congestive heart failure can be associated with theophylline toxicity, even at normal theophylline levels. If theophylline must be administered, the dosing should be reduced in the heart failure patient.

2022 AHA/ACC/ HFSA Heart Failure Guideline (DO NOT EDIT) [18]

Drugs of Unproven Value or That May Worsen HF

Class III (No Benefit)
"1. In patients with HFrEF, dihydropiridine calcium channel-blocking drugs are not recommended treatment for HF.[19][20] (Level of Evidence: A) "
"2. In patients with HFrEF, vitamins, nutritional supplements, and hormonal therapy are not recommended other than to correct specific deficiencies. [21][22][23][24][25][26][27] (Level of Evidence: B-R) "
Class III (Harm)
"3. In patients with HFrEF, non-dihydropiridine calcium channel-blocking drugs are not recommended. [28][29][30][31] (Level of Evidence: A) "
"4.In patients with HFrEF, class IC antiarrhythmic medications and dronedarone may increase the risk of mortality. [32][33][34] (Level of Evidence: A) "
"5.In patients with HFrEF, thiazolidinediones increase the risk of worsening HF symptoms and hospitalizations. [35][36][37][38][39](Level of Evidence: A) "
"6.In patients with type 2 diabetes and high cardiovascular risk, the dipeptidyl peptidase-4 (DPP-4) inhibitors saxagliptin and alogliptin increase the risk of HF hospitalization and should be avoided in patients with HF. [40][41][42](Level of Evidence: B-R) "
"7.In patients with HFrEF, NSAIDs worsen HF symptoms and should be avoided or withdrawn whenever possible. [43][44][45][46] (Level of Evidence: B-NR) "

References

  1. ↑ Packer M, Kessler PD, Lee WH (1987). "Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far". Circulation. 75 (6 Pt 2): V56–64. PMID 3552317. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA (2004). "Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT)". American Heart Journal. 148 (1): 122–8. doi:10.1016/j.ahj.2003.12.040. PMID 15215801. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
  3. ↑ Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ (1999). "Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group". The New England Journal of Medicine. 341 (12): 857–65. doi:10.1056/NEJM199909163411201. PMID 10486417. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
  4. ↑ Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A (1998). "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics". Archives of Internal Medicine. 158 (10): 1108–12. PMID 9605782. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  5. ↑ Gan SC, Barr J, Arieff AI, Pearl RG (1992). "Biguanide-associated [[lactic acidosis]]. [[Case report]] and review of the literature". Archives of Internal Medicine. 152 (11): 2333–6. PMID 1444694. Retrieved 2011-04-08. Unknown parameter |month= ignored (help); URL–wikilink conflict (help)
  6. ↑ Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM (2005). "Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study". Circulation. 111 (5): 583–90. doi:10.1161/01.CIR.0000154542.13412.B1. PMID 15699279. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  7. ↑ Swenson JR, Doucette S, Fergusson D (2006). "Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials". Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 51 (14): 923–9. PMID 17249635. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  8. ↑ Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  9. ↑ Storen EC, Tefferi A (2001). "Long-term use of anagrelide in young patients with essential thrombocythemia". Blood. 97 (4): 863–6. PMID 11159509. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  10. ↑ "Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group". The American Journal of Medicine. 92 (1): 69–76. 1992. PMID 1731512. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  11. ↑ Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, Tawakol A, Gerszten RE, Systrom DM, Bloch KD, Semigran MJ (2007). "Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension". Circulation. 116 (14): 1555–62. doi:10.1161/CIRCULATIONAHA.107.716373. PMID 17785618. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  12. ↑ Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L (2001). "Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2". The New England Journal of Medicine. 344 (11): 783–92. doi:10.1056/NEJM200103153441101. PMID 11248153. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  13. ↑ Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT (2003). "Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial". Circulation. 107 (25): 3133–40. doi:10.1161/01.CIR.0000077913.60364.D2. PMID 12796126. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  14. ↑ Yap YG, Camm AJ (2003). "Drug induced QT prolongation and torsades de pointes". Heart (British Cardiac Society). 89 (11): 1363–72. PMC 1767957. PMID 14594906. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  15. ↑ 15.0 15.1 Packer M, Gottlieb SS, Kessler PD (1986). "Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia". The American Journal of Medicine. 80 (4A): 23–9. PMID 2871753. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  16. ↑ Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995). "A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure". The New England Journal of Medicine. 333 (18): 1190–5. doi:10.1056/NEJM199511023331806. PMID 7565975. Retrieved 2011-04-10. Unknown parameter |month= ignored (help)
  17. ↑ Philbin EF (1999). "Comprehensive multidisciplinary programs for the management of patients with congestive heart failure". Journal of General Internal Medicine. 14 (2): 130–5. PMID 10051785. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  18. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  19. ↑ Packer M, O'Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN; et al. (1996). "Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group". N Engl J Med. 335 (15): 1107–14. doi:10.1056/NEJM199610103351504. PMID 8813041.
  20. ↑ Packer M, Carson P, Elkayam U, Konstam MA, Moe G, O'Connor C; et al. (2013). "Effect of amlodipine on the survival of patients with severe chronic heart failure due to a nonischemic cardiomyopathy: results of the PRAISE-2 study (prospective randomized amlodipine survival evaluation 2)". JACC Heart Fail. 1 (4): 308–314. doi:10.1016/j.jchf.2013.04.004. PMID 24621933.
  21. ↑ Djoussé L, Cook NR, Kim E, Bodar V, Walter J, Bubes V; et al. (2020). "Supplementation With Vitamin D and Omega-3 Fatty Acids and Incidence of Heart Failure Hospitalization: VITAL-Heart Failure". Circulation. 141 (9): 784–786. doi:10.1161/CIRCULATIONAHA.119.044645. PMC 7054158 Check |pmc= value (help). PMID 31709816.
  22. ↑ Wang T, Liu Z, Fu J, Min Z (2019). "Meta-analysis of vitamin D supplementation in the treatment of chronic heart failure". Scand Cardiovasc J. 53 (3): 110–116. doi:10.1080/14017431.2019.1612084. PMID 31032644.
  23. ↑ Zittermann A, Ernst JB, Prokop S, Fuchs U, Gruszka A, Dreier J; et al. (2019). "Vitamin D supplementation of 4000 IU daily and cardiac function in patients with advanced heart failure: The EVITA trial". Int J Cardiol. 280: 117–123. doi:10.1016/j.ijcard.2019.01.027. PMID 30654912.
  24. ↑ Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM; et al. (2005). "Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial". JAMA. 293 (11): 1338–47. doi:10.1001/jama.293.11.1338. PMID 15769967.
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  27. ↑ Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A; et al. (2014). "Coenzyme Q10 for heart failure". Cochrane Database Syst Rev (6): CD008684. doi:10.1002/14651858.CD008684.pub2. PMID 24049047.
  28. ↑ "Effect of verapamil on mortality and major events after acute myocardial infarction (the Danish Verapamil Infarction Trial II--DAVIT II)". Am J Cardiol. 66 (10): 779–85. 1990. doi:10.1016/0002-9149(90)90351-z. PMID 2220572.
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  34. ↑ Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Lévy S, Crijns H; et al. (2008). "Increased mortality after dronedarone therapy for severe heart failure". N Engl J Med. 358 (25): 2678–87. doi:10.1056/NEJMoa0800456. PMID 18565860.
  35. ↑ Lipscombe LL, Gomes T, Lévesque LE, Hux JE, Juurlink DN, Alter DA (2007). "Thiazolidinediones and cardiovascular outcomes in older patients with diabetes". JAMA. 298 (22): 2634–43. doi:10.1001/jama.298.22.2634. PMID 18073359. Review in: ACP J Club. 2008 Jun 17;148(4):13
  36. ↑ Lago RM, Singh PP, Nesto RW (2007). "Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials". Lancet. 370 (9593): 1129–36. doi:10.1016/S0140-6736(07)61514-1. PMID 17905165. Review in: ACP J Club. 2008 Mar-Apr;148(2):39
  37. ↑ Dargie HJ, Hildebrandt PR, Riegger GA, McMurray JJ, McMorn SO, Roberts JN; et al. (2007). "A randomized, placebo-controlled trial assessing the effects of rosiglitazone on echocardiographic function and cardiac status in type 2 diabetic patients with New York Heart Association Functional Class I or II Heart Failure". J Am Coll Cardiol. 49 (16): 1696–704. doi:10.1016/j.jacc.2006.10.077. PMID 17448371.
  38. ↑ Home PD, Pocock SJ, Beck-Nielsen H, Curtis PS, Gomis R, Hanefeld M; et al. (2009). "Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial". Lancet. 373 (9681): 2125–35. doi:10.1016/S0140-6736(09)60953-3. PMID 19501900. Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-8 Review in: Evid Based Med. 2009 Dec;14(6):168
  39. ↑ Giles TD, Miller AB, Elkayam U, Bhattacharya M, Perez A (2008). "Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction". J Card Fail. 14 (6): 445–52. doi:10.1016/j.cardfail.2008.02.007. PMID 18672190.
  40. ↑ Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P; et al. (2014). "Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial". Circulation. 130 (18): 1579–88. doi:10.1161/CIRCULATIONAHA.114.010389. PMID 25189213. Review in: Ann Intern Med. 2015 Apr 21;162(8):JC11
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  44. ↑ Hudson M, Richard H, Pilote L (2005). "Differences in outcomes of patients with congestive heart failure prescribed celecoxib, rofecoxib, or non-steroidal anti-inflammatory drugs: population based study". BMJ. 330 (7504): 1370. doi:10.1136/bmj.330.7504.1370. PMC 558290. PMID 15947399.
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  46. ↑ Feenstra J, Heerdink ER, Grobbee DE, Stricker BH (2002). "Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study". Arch Intern Med. 162 (3): 265–70. doi:10.1001/archinte.162.3.265. PMID 11822918.

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