The American Heart Association (AHA) has released a scientific statement cautioning against the use of some common drugs and supplements in patients with heart failure (HF).
The statement, published this month in Circulation, said certain medications can cause heart-related problems by:
• Being toxic to heart muscle cells or changing how the heart muscle contracts.
• Interacting with HF medications, which means some of their benefits are lost.
• Containing more sodium than advised for patients with HF.
For example, commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can trigger or worsen HF by causing sodium and fluid retention and rendering diuretic medications less effective. Meanwhile, OTC heartburn medications and cold treatments may also contain significant amounts of sodium, which is normally restricted in patients with HF.
The AHA advised that many supplements can be dangerous for HF patients, including products containing ephedra, which is known to increase blood pressure, and others that interfere with one or more commonly used HF medications, such as St. John’s wort, ginseng, hawthorn, danshen, and green tea.
The AHA noted that HF patients have 5 or more different medical conditions and take 7 or more prescription medications daily, on average. Pitfalls of this polypharmacy include increased risk of adverse drug events, drug-drug interactions, and medication nonadherence.
“Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurological conditions, or infections, it is crucial but difficult for health care providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse,” said Robert L. Page II, PharmD, MSPH, chair of the writing committee for the new scientific statement. “…Ideally, there should be a ‘captain’ who oversees your medications. This person might be a physician, advanced practice nurse, nurse, or a pharmacist who is managing your heart failure.”
One article previously published in Heart Failure Clinics extolled the value of including pharmacists on the HF care team, noting that medication management is at the core of HF therapy.
For instance, HF patients often require drug changes, dose adjustments, and dose titrations, and clinical pharmacists can educate their patients and colleagues, monitor adherence, watch for drug interactions and intolerances, and conduct medication reconciliation during transitions of care.
The article also cited studies that demonstrated how pharmacist interventions reduce medication errors, advance patient knowledge, improve treatment adherence, optimize medication use, and decrease costs. The end result specific to HF is reduced mortality and cardiovascular events.
Pharmacists are well positioned to review patients’ medication regimens to ensure that no offending drugs are listed. Their advanced knowledge of prescription and OTC medications, herbal supplements, and drug-drug interactions is a proven advantage for medical teams, and they effectively reduce polypharmacy.