Why They Worsen Heart Failure
For people with congestive heart failure, even short-term use of NSAIDs can increase blood pressure and interfere with blood-pressure-lowering drugs. When blood pressure is high, the heart must work harder to pump blood which can contribute to weakening of the heart muscle over time.
Many over-the-counter cough and cold medications contain an NSAID and so it’s important to read labels before taking one if you’ve also recently taken a multi-symptom drug .
Isosorbide Dinitrate And Hydralazine
- Dilate blood vessels to improve the amount of blood the heart pumps to the body.
- Combination may be particularly beneficial in African American patients.
- Effective for heart failure even in patients without high blood pressure.
- Headache. Common after this combination is started can take Tylenol® to control. Should become less intense with time.
- Low blood pressure. Check your blood pressure at home.
- Medications for erectile dysfunction interact with isosorbide dinitrate, and should be avoided.
- Dizziness. Take separately from other medications that cause dizziness.
- Get up more slowly from lying or seated position.
- Nausea. May take with small frequent meals.
What Drugs Should Be Avoided In Chronic Heart Failure
Several groups of drugs can induce or exacerbate chronic heart failure , notably those which increase preload or afterload and/or have negative inotropic properties . The most susceptible patients are those with preexisting left ventricular dysfunction who are already at risk of heart failure.
Table I. Drugs that induce or exacerbate chronic heart failure .
The following drugs should be combined with caution, or avoided, with any form of heart failure treatment.
Nonsteroidal anti-inflammatory drugs
NSAIDs are associated with fluid retention and the induction of CHF, primarily because they interfer with prostaglandin biosynthesis by inhibiting the function of the enzyme cyclooxygenase.
In patients with impaired left ventricular function, renal perfusion is maintained by prostaglandins, which reduce afferent arteriolar resistance, and by angiotensin II, which increases efferent arteriolar resistance. Angiotensin-converting enzyme inhibition may reduce this effect of angiotensin II. NSAIDs can offset the significant contribution of prostaglandins to the preservation of adequate renal function in heart failure. Thus, impaired renal function is more frequent in elderly patients using NSAIDs with a long half-life or combined with diuretics or ACE inhibitors.. Ongoing NSAID use doubles the risk of hospitalization for CHF. The risk is dose-dependent, higher with NSAIDs having a long half-life, and higher in the first month of therapy.
Class I antiarrhythmics
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Cough And Cold Medications
Many of these medications contain NSAIDs to relieve pain. They also often have in them, which can make your heart disease worse in these ways:
- Your blood pressure and heart rate may go up.
- The meds may prevent your heart disease medicine from working right.
Including Infliximab Etanercept And Adalimumab
Use with caution in patients with mild HF or decreased left ventricular function. Infliximab doses > 5 mg/kg are contraindicated with moderate to severe HF . In a scientific statement from AHA, TNF blockers have been determined to cause either direct myocardial toxicity or exacerbate underlying myocardial dysfunction, 2016 .
5. Antiarrhythmic medications:
Class I: Flecainide, disopyramide
Class III: Dronedarone, Sotalol
6. Anti- Cancer medications:
Anthracyclines: doxorubicin, Daunorubicin, Mitoxantrone
US Boxed Warning: Myocardial damage can occur with doxorubicin with incidences from 1% to 20% for cumulative doses from 300 mg/m2 to 500 mg/m2 when administered every 3 weeks è monitor LVEF before, during and after treatment
Targeted therapy: Bevacizumab, Lapatinib, Trastuzumab
US Boxed Warning: Trastuzumab is associated reductions in left ventricular ejection fraction and heart failure the incidence is highest in patients receiving trastuzumab with an anthracycline-containing chemotherapy regimen è Evaluate LVEF in all patients prior to and during treatment discontinue for cardiomyopathy
This is a selective inhibitor of phosphodiesterase type 3, antiplatelet and vasodilatory agent used primarily in patients with intermittent claudication and peripheral arterial disease .
US Boxed Warning: Cilostazol is contraindicated in patients with heart failure of any severity è causing decreased survival in patients with class III to IV heart failure .
9. 1 -Blockers:
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How Can Hormonal Therapies Worsen Heart Failure
Estrogen-based medications can raise your blood pressure and your risk of blood clots. The longer you take them, the higher your risk. High blood pressure can make it harder for your heart to pump properly, which is already difficult if you have heart failure. Clots can cut off blood supply to different organs and cause permanent damage to your heart.
Testosterone-based treatments affect heart failure differently. You can experience some symptom relief like being able to exercise easier but these medications can also cause your body to hold on to more water and salt. If you are using testosterone and have heart failure, your provider may choose to have more frequent follow-up appointments with you.
How To Slash Salt
Here are a few ways you can reduce the sodium in your diet, according to the U.S. Dietary Guidelines for Americans.
Read the Nutrition Facts labels on food when grocery shopping.
Consume more fresh fruit and vegetables, which are naturally low in sodium.
Prepare more food yourself using less salt. When eating at restaurants, ask for lower-sodium options, if available.
Eat less pizza, bread, and other processed food.
Track what you eat.
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Medicines For Heart Failure
Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines.
Some of the main medicines for heart failure include:
- ACE inhibitors
- hydralazine with nitrate
You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects.
What Medications Improve Outcomes In Patients With This Condition
Several medications have been shown by well-designed studies to reduce morbidity and mortality. After use of a loop diuretic, low-dose angiotensin-converting enzyme inhibitors or angiotensin receptor blockers should be started.1,2 When combined with an ACE inhibitor or ARB, specific -blockers also reduce mortality .1,2 There is no difference in outcomes in patients started on an ACE inhibitor or -blocker first.3 In patients intolerant of ACE inhibitors or ARBs, a hydralazinenitrate combination has been shown to improve mortality, hospital admission and symptoms, particularly in African-American patients.1,2 In patients with persistent symptoms, spironolactone or eplerenone reduce mortality .1,2 These medications should be started at low doses and titrated every two to four weeks, with close monitoring.1,2 A recent large trial showed that LCZ696, a drug that combines an ARB and with a neprilysin inhibitor, provided a mortality benefit as compared with ACE inhibitors.4 These data have not yet been integrated into guidelines.
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What Are The Symptoms
The most common symptoms of heart failure include fatigue, shortness of breath, wheezing, frequent coughing, and swollen ankles and neck veins . All of these are due to excess fluid buildup in the body. As the heart struggles to pump, blood and fluid can back up in the veins and build up in various areas of the body, such as the feet, ankles, and legs. In some cases, fluid can back up into the lungs. This condition is called pulmonary edema and it can be a medical emergency. Signs of pulmonary edema include waking up at night short of breath or needing to sleep in a chair or with your head propped up on extra pillows.
How Can Stimulants Worsen Heart Failure
Because of how these medications help increase alertness and attention, they can also raise your blood pressure and heart rate. The higher those two numbers go, the more strain it puts on your heart to pump blood properly. If you have heart failure, your heart is already working harder than the hearts of people without heart failure, so any added stress can worsen your condition.
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Classes Of Medications For Heart Failure
Doctors use a variety of medicines to manage heart failure. This includes drugs that reduce the hearts workload, help the heart pump more blood, and reduce fluid buildup in the body. Your doctor may also recommend drugs to prevent and reduce cholesterol. Most people with heart failure take more than one medication.
Classes of heart failure drugs include:
To help doctors choose the best treatment, they follow expert guidelines and recommendations. Your doctor will consider your symptoms, test results, and stage of heart failure. After starting treatment, your doctor will monitor your response. It may be necessary to adjust your dose, change drugs, or add another drug for optimal treatment.
Which Drugs Should Be Avoided By Patients With Heart Failure
Drugs that can exacerbate heart failure should be avoided, such as nonsteroidal anti-inflammatory drugs , calcium channel blockers , and most antiarrhythmic drugs . NSAIDs can cause sodium retention and peripheral vasoconstriction, and they can attenuate the efficacy and enhance the toxicity of diuretics and ACEIs. Calcium channel blockers can worsen heart failure and may increase the risk of cardiovascular events only the vasoselective CCBs have been shown not to adversely affect survival. Antiarrhythmic agents can have cardiodepressant effects and may promote arrhythmia only amiodarone and dofetilide have been shown not to adversely affect survival.
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If You Have Diabetes Or Prediabetes
HOW GLUCOSE AFFECTS YOUR HEART
Elevated blood glucose level can lead to changes in the circulatory system. These changes may cause damage to your heart.
KEEPING YOUR BLOOD GLUCOSE LEVELS HEALTHY
- Take your medications as prescribed
- Learn about managing diabetes by attending a diabetes education program
- Monitor and keep track of your blood glucose
- Target: blood glucose before meals between 4.0 and 7.0 mmol/L
- Target: blood glucose two hours after meals between 5.0 and 10.0 mmol/L
- Aim to make healthier food choices
- Be active every day
- Follow your Physical Activity Plan
- Visit your family doctor or diabetes specialist regularly
- Additional Meal Planning Tips:
- Eat regular meals. Aim to eat every four to six hours. Include a healthy snack if meals are more than four to six hours apart.
- Eat breakfast.
- Limit sugars and sweets such as sugar, regular soft drinks, fruit drinks, desserts, candies, jam, syrup and honey.
- If you are thirsty, drink water or sugar free drinks. Drinking regular soft drinks, sweetened drinks or fruit juices will raise your blood sugar level. Remember to stay within your fluid restriction as prescribed by your doctor.
Who Is Affected By Heart Failure
Heart failure is a chronic disease that afflicts mostly seniors, but younger people can also develop the condition because of a reaction to a viral infection, abuse of alcohol or illicit drugs, such as methamphetamine or cocaine, or for unknown reasons.
About 5.8 million people in the U.S. have heart failure, according to the National Heart, Lung, and Blood Institute. The number of people each year who are hospitalized because of the condition has more than doubled over the last three decades to more than 1.1 million.
If heart failure is isn’t treated, or treated well enough, it often gets worse over time. The heart then loses its pumping capacity little by little over the years. The heart compensates at firstby enlarging or pumping faster, for example. This can mask the condition. But over time, the heart can no longer compensate, and symptoms develop.
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What Causes Heart Failure
The main causes of heart failure include heart disease, high blood pressure, and diabetes. Several other conditions also increase the risk, including certain heart-valve disorders, heart defects that have been present since birth, heart muscle disease , high cholesterol, irregular heartbeat , an overactive thyroid gland, or abuse of alcohol or illicit drugs.
All of those conditions can prevent the heart from contracting forcefully enough to expel all the blood from its main pumping chamber, a condition known as systolic heart failure. Or the heart can become overly stiff, preventing the chamber from filling before it contracts. That’s called diastolic heart failure, an equally common form that affects about 50 percent of patients.
Work With Your Doctor
Keep everyone on your health care team in the loop about the drugs and supplements you take. This keeps your risk low. Itâs also a good idea to limit any drugs or supplements you donât need. Some tips:
- At each doctor visit, provide a list of each drug and supplement you take. Include the dose and how often you take it.
- Ask your doctor if there are any medications you can limit or stop taking.
- If you have multiple doctors, ask one to be in charge of your medications. Update them when you get a new prescription or when one of your prescriptions changes. That way youâll know about any increased heart risk before you make a medication change.
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Cases And Controls Selection
We created a set of cases by identifying all individuals hospitalized during the follow-up. A hospitalization was defined as a stay longer than 1 day in an acute care hospital. The first day of the first hospitalization constitutes the event date. For each case, we randomly paired 4 to 10 controls using incidence density sampling. Incidence density sampling assures that the observation period is identical for a given case and its controls. Controls and cases were matched according to age group, sex, calendar year at time of HF diagnosis, record of an ischemic heart disease, and record of a diabetes diagnosis in the 365 days prior the HF diagnosis. The event date for controls was the date when the matched case was hospitalized.
Left Ventricular Assist Devices
Left ventricular assist devices are mechanical pumps that can help if your left ventricle isn’t working properly and medication alone isn’t helping.
They may be used as a permanent treatment if you can’t have a heart transplant, or as a temporary measure while you wait for a transplant.
In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.
Read more about LVADs on the British Heart Foundation website.
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Independent Variable: Exposure To A Potentially Inappropriate Drug
For each of the potentially inappropriate drug class examined , we classified patients as user or nonuser. Among dihydropyridine CCBs, only nifedipine was considered as there is evidence of contra-indications in heart failure only for that drug. We searched for a claim for a contra-indicated drug class in the 365 days before HF diagnosis and between HF diagnosis and the event date. We selected the claim closest to the event date and then determined the exposure time period by adding 1.5 times the number of days supply to this last claim date. If the event date occurred in the exposure time period, we deemed the patient as being a user. We repeated the process for each medication class.
Manage Your Medications Safely
Knowledge Is the Best Medicine
1. When you receive a prescription from the doctor, make sure you ask:
- What is the brand name and chemical name of the medication?
- Why is it being prescribed?
- When and how should it be taken?
- How long will you need to take it?
- What side effects should you expect to have?
- What should you do about the side effects?
2. When you pick up your medication, ask your pharmacist to:
- Explain the best way to take the medication
- Describe what is written on the label
- Provide written information about the medication
3. Try to use the same pharmacy for all of your prescriptions. It is important for your pharmacist to have a complete list of your medications. Your pharmacist can then evaluate whether your medications can be safely taken together.
4. Carry your medication list with you. Make sure the list includes:
- All of your medications, as well as any vitamins, supplements and herbals
- Your allergies, immunizations and pharmacy phone number
Bring the pill bottles or a list of your current medications to all visits with your doctors.
5. Always ask your doctor or pharmacist before taking any medications or herbal products you can buy without a prescription. Medications you can buy over the counter at the drug store include pain medication, antacids, laxatives and cough medicines.
Non-steroidal anti-inflammatory drugs , such as ibuprofen and naproxen , may worsen your symptoms and/or make your prescription medication less effective.
- Phone: 1-800-575-5386
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How Is Heart Failure With Reduced Ejection Fraction Diagnosed
Heart failure with reduced ejection fraction is a clinical syndrome of dyspnea, exercise intolerance and/or edema resulting from an impairment of ejection of blood, usually documented by a left ventricular ejection fraction of 40% or less on echocardiography.1,2 Coronary artery disease is a major cause therefore, stress testing or, in the presence of angina, coronary angiography should be performed.1,2 Recommended testing includes electrocardiography, complete blood count, urinalysis, and measurement of electrolytes, creatinine, thyroid-stimulating hormone, glucose and brain natriuretic peptide.2 Other investigations should be individually tailored, with a focus on potentially reversible causes.
Other Medications And Supplements That Can Worsen Heart Failure
There are many other medications and supplements that can worsen heart failure besides these five. Some of those include chemotherapy, heartburn medications, medications for the common cold, decongestants like Sudafed, herbal remedies like ginseng, and some seizure medications.
One thing you should also be careful of is when sodium is added to medications to help them work correctly in your body. Effervescent products like Alka-Seltzer are a good example of this issue, as they can contain several hundred milligrams of sodium per serving. Taking extra sodium can cause your body to hold on to more water. Be sure to read labels carefully and ask your pharmacist if any of your prescription medications have sodium in them.
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