Drugs That Worsen Heart Failure Common in Hospitalized HF

[Lawpy]

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I got this in an email from Medscape so curious to know your thoughts:

Drugs That Worsen Heart Failure Common in Hospitalized HF

Commonly prescribed medications that exacerbate heart failure are often continued after — or even started during — HF hospitalization, new research suggests.

www.medscape.com

Here's the study:

Prescribing Patterns of Heart Failure-Exacerbating Medications Following a Heart Failure Hospitalization | JACC: Heart Failure

Also: https://ahajournals.org/doi/full/10.1161/cir.0000000000000426

 

[deleted480308]

I’m not buying the suggestion to stop metformin and albuterol

Dilt is a black box in hfref though if i recall correctly

 

[BigRedBeta]

Medicine is risk management. The sooner you recognize that the true art of being a physician is mitigating risk from competing interests, the better you'll be for your patients. This is especially true for those who will provide a 'medical home' model of care (General pediatrics, FM, IM) as well as those specialties that are more generalist in nature - critical care, anesthesia. The danger to patients is subspecialists who lack the ability to think outside of their specific organ system...

The study referenced really elicits a big "so what?". They don't demonstrate any patient level outcomes, they don't quantify the relative risk increase for any of those medications, they don't demonstrate that stopping the medications actually improves HF issues or that stopping these meds doesn't impact the comorbidities.

 

[aafisahar]

I’m not buying the suggestion to stop metformin and albuterol

Dilt is a black box in hfref though if i recall correctly

Albuterol isn't disease modifying in COPD, just symptom relief. If it drives tachycardia because patients are using it inappropriately, it could cause more exacerbations. Different story in asthma.

Metformin, maybe if they have labile kidney function but more likely just random sampling error. You test enough drugs and a few significant interactions will happen by pure chance.

 

[Instatewaiter]

That list is pretty hit or miss. Some are exactly right, others make little sense.

Dilt is class III (harm) in the hf guidelines- sure makes sense. Sotalol increases mortality as does dronedarone and a slew of others on the list.

Half of these are assenine- they are needed for certain disease conditions... sorry ma'am but we can't give you an anthracyclines for your breast cancer because they may harm your mildly reduced ejection fraction. Sorry sir but you renal cell carcinoma therapy shouldn't be used because it may cause you Hypertension...

Metformin... Based upon "expert" opinion.

 

[Chemist0157]

I am not sure what to make of that. Beyond diltiazem or NSAIDs, I do not think I would readily change someone's medication list based on this study. I cannot speak to albuterol. I see many diabetics though not for their diabetes. There are benefits to metformin, and not everybody can be controlled on glipizide alone or needs insulin. Perhaps it would prompt a consideration for a change to an SGLT2 inhibitor, but beyond that, I do not feel compelled to change much else.