Almost 25% of HFrEF patients prescribed drugs that could worsen their condition

Nearly a quarter of adults living with heart failure with reduced ejection fraction (HFrEF) are prescribed at least one pharmaceutical that could exacerbate their condition, according to a study published in the American Journal of Cardiology Feb. 10.

Most recent heart failure (HF) guidelines consider drugs like non-steroidal anti-inflammatory agents (NSAIDs), non-dihydropyridine calcium channel blockers, thiazolidinediones and antiarrhythmics class III treatment recommendations, first author Paulino A. Alvarez, MD, and colleagues wrote in the journal. That means HF patients should avoid them if they want to optimize their heart health. In 2016 the American Heart Association added weight to those recommendations, publishing its own evidence-based list of drugs that might interfere with HF.

First on the AHA’s list were NSAIDs, followed by:

  • Diabetes drugs (thiazolidinediones, Saxagliptin, Sitagliptin)
  • Antiarrhythmic medications (Flecainide, Disopyramide, Sotalol, Dronedarone)
  • Antihypertensives (Doxazosin, Diltiazem, Verapamil)
  • Hematologic medications (Cilostazol)
  • Neurological and psychiatric agents (stimulants, antidepressants, appetite suppressants)
  • Pulmonary medications (Bosentan)

Alvarez, of the University of Iowa, and co-authors evaluated the prevalence of potentially harmful drug (PHD) prescriptions in 40,966 patients diagnosed with HFrEF between 2011 and 2014. The researchers defined drug safety according to AHA standards.

Alvarez et al. reported that during the study period, 24.2 percent of patients were prescribed at least one PHD that might have exacerbated their HF symptoms. Of the 9,954 patients who were prescribed PHDs, NSAIDs were the most commonly prescribed (67.4 percent prevalence), followed by antihypertensives (24 percent), diabetes drugs (23.3 percent), neurological and psychiatric medications (21 percent) and antiarrhythmic medications (12.6 percent).

“The majority of patients who received a PHD were prescribed more than once a potentially harmful drug,” the authors wrote. “For instance, there were 6,710 individuals who were prescribed and filled at least one NSAID medication, but the total number of NSAID medications prescribed was 29,985. This accounted for approximately 4.5 NSAID prescriptions per person prescribed an NSAID.”

There were also noticeable differences between patients prescribed PHDs and those who weren’t, Alvarez and colleagues said. For example, patients on PHDs were more likely to be female and had a higher prevalence of comorbidities like diabetes (58.4 percent in the PHD group vs. 46.4 percent in the non-PHD group), hypertension (91 percent vs. 85.2 percent), obesity (38.6 percent vs. 29.6 percent), atrial fibrillation (38.9 percent vs. 32.8 percent) and depression (31 percent vs. 21.8 percent).

“The prescription of potentially harmful drugs among adult patients with systolic heart failure is frequent,” the authors said. “Adherence to the ACC/AHA guidelines and careful review of medication lists by prescribing physicians and especially cardiologists is crucial. Furthermore, monitoring strategies should be incorporated in electronic medical records and prescription systems to detect and prevent, if possible, prescription of PHDs.”