Abstract
Background
Heart failure (HF) is a pervasive global health concern, with acute decompensated heart failure (ADHF) contributing significantly to morbidity and mortality. Medications used in patients with HF may exacerbate HF or prolong the QT interval, posing additional risks.
Objective
The objective is to assess the prevalence and utilization patterns of medications known to cause or exacerbate HF and prolong the QT interval among patients with ADHF. Understanding these patterns is crucial for optimizing patient care and minimizing potential risks.
Methods
A retrospective chart review was conducted at Huntsville Hospital, Huntsville, USA, covering 602 patients with ADHF over a 40-month period. Inclusion criteria involved age ≥ 18 years, a history of HF, and ADHF admission. The 2016 American Heart Association Scientific Statement was used to identify drugs that may cause or exacerbate HF and those that could prolong the QT interval
Results
Among the 602 patients, 57.3% received medications causing or exacerbating HF, notably albuterol (34.9%) and diabetes medications (20.4%), primarily metformin, followed by urologic agents (14.3%), mostly tamsulosin, and nonsteroidal anti-inflammatory drugs (NSAIDs) (6.1%). Moreover, 82.9% were on medications prolonging the QT interval, with loop diuretics, amiodarone, ondansetron, and famotidine most prevalent. Furthermore, 42.1% of the patients received more than two concomitant medications that prolong the QT interval, which can further exacerbate the risk of torsades de pointes.
Conclusion
This study underscores the high prevalence of HF-causing or HF-exacerbating medications and QT-prolonging drugs in patients with ADHF. Healthcare professionals must be cognizant of these patterns, advocating for safer prescribing practices to optimize patient outcomes and reduce the burden of HF-related hospitalizations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858.
Dharmarajan K, Hsieh AF, Kulkarni VT, Lin Z, Ross JS, Horwitz LI, Kim N, Suter LG, Lin H, Normand SL, et al. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. BMJ. 2015;350: h411. https://doi.org/10.1136/bmj.h411.
Verbrugge FH, Guazzi M, Testani JM, Borlaug BA. Altered hemodynamics and end-organ damage in heart failure: impact on the Lung and kidney. Circulation. 2020;142:998–1012. https://doi.org/10.1161/CIRCULATIONAHA.119.045409.
Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126:501–6. https://doi.org/10.1161/CIRCULATIONAHA.112.125435.
Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, Normand SL, Schreiner G, Spertus JA, Vidán MT, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. 2010;3:97–103. https://doi.org/10.1161/CIRCHEARTFAILURE.109.885.
Page RL II, O’Bryant CL, Cheng D, et al. Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association. Circulation. 2016;134(6):e32-69.
Teerlink J, Alburikan K, Metra M, Rodgers J. Acute decompensated heart failure update. Curr Cardiol Rev. 2015;11(1):53–62.
Goyal P, Kneifati-Hayek J, Archambault A, Mehta K, Levitan EB, Chen L, Diaz I, Hollenberg J, Hanlon JT, Lachs MS, Maurer MS. Prescribing patterns of heart failure-exacerbating medications following a heart failure hospitalization. JACC Heart Fail. 2020;8(1):25–34.
Kneifati-Hayek J, Kennel P, Bryan J, Safford MM, Goyal P. Use of heart failure-exacerbating medications among adults with heart failure. J Cardiac Fail. 2019;25(1):72–3.
Cazzola M, Matera MG, Donner CF. Inhaled beta2-adrenoceptor agonists: cardiovascular safety in patients with obstructive lung disease. Drugs. 2005;65:1595–610.
US Food and Drug Administration. FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. https://www.fda.gov/media/96771/download. Accessed 3 Aug 2023.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-421.
Dhaliwal AS, Habib G, Deswal A, Verduzco M, Souchek J, Ramasubbu K, Aguilar D, Ma TS, Jneid HM, Bolos M, Bozkurt B. Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure. Am J Cardiol. 2009;104:270–5.
Huerta C, Varas-Lorenzo C, Castellsague J, García Rodríguez LA. Non-steroidal anti-inflammatory drugs and risk of first hospital admission for heart failure in the general population. Heart. 2006;92:1610–5. https://doi.org/10.1136/hrt.2005.082388.
Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an underrecognized public health problem. Arch Intern Med. 2000;160:777–84.
Tisdale JE, Chung MK, Campbell KB, Hammadah M, Joglar JA, Leclerc J, Rajagopalan B. American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Drug-induced arrhythmias: a scientific statement from the American Heart Association. Circulation. 2020;142(15):e214–33.
Acknowledgements
The author is immensely grateful to Huntsville Hospital’s Pharmacy department for their considerable help and support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No sources of funding were used to conduct this study or prepare this manuscript.
Conflict of interest
M.S.T. has no conflicts of interest that are directly relevant to the content of this article.
Data availability statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval
Ethical approval was waived by the Institutional Review Committee of Huntsville Hospital in view of the retrospective nature of the study.
Code availability
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Author contributions
The author M.S.T. contributed to the study conception and design. He performed material preparation, data collection and analysis, and the first draft of the manuscript was written by him and he read and approved the final manuscript.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sheikh-Taha, M. The Use of Drugs that Should be Avoided or Used with Caution in Patients Hospitalized for Acute Decompensated Heart Failure. Am J Cardiovasc Drugs (2024). https://doi.org/10.1007/s40256-024-00663-3
Accepted:
Published:
DOI: https://doi.org/10.1007/s40256-024-00663-3