AHA Scientific Statement: Drug-Drug Interactions in Heart Failure

AHA Statement on Heart Failure Drug Interactions
AHA Statement on Heart Failure Drug Interactions
The American Heart Association compiled a comprehensive drug list and made 9 major recommendations to help guide clinicians who treat patients with heart failure.

The American Heart Association (AHA) released a scientific statement describing drugs that may exacerbate or cause heart failure.

Published in Circulation, the statement is intended to guide clinicians who treat patients with heart failure to make more informed medication choices, and ultimately, improve quality of care.

“Patients with heart failure often have a high medication burden consisting of multiple medications and complex dosing regimens,” the authors wrote. “On average, heart failure patients take 6.8 prescription medications per day, resulting in 10.1 doses a day. This estimate does not include over-the-counter (OTC) medications or complementary and alternative medications (CAMs).”

The AHA writing committees studied case reports, case series, package inserts, and other relevant materials to compile a list of prescription medications that “may cause myocardial toxicity or exacerbate underlying myocardial dysfunction, leading to the precipitation or induction of heart failure.”

The drug list included analgesics, anesthesia medications, antidiabetic and antihypertensive medications, anti-infective medications, anticancer medications, hematologic medications, psychiatric medications, urological medications, and OTCs/CAMs, among others. They reviewed and detailed the effects of individual agents within each therapeutic area.

Among their 9 recommendations, the AHA first recommended healthcare providers should conduct a comprehensive medication review at each visit and admission. Patients should be asked about drug, dose, and frequency, including OTCs and CAMs. The AHA also recommended the use of a “medication flow sheet,” to be updated as needed, and to include any relevant laboratory tests.

Clinicians should continually evaluate risks and benefits associated with each medication and, if necessary, consider discontinuation. Also, when possible and affordable, the AHA recommended combining medications to reduce the number of medications taken per day or if doing so could treat more than one condition.

Patients should be educated on OTCs and CAMs, particularly agents that have uncertain efficacy and safety. These medications should also be evaluated for their sodium content.

Finally, a “team management approach” may also be considered. Patients should notify the “captain” of said team should any medications are changed or added.

“Polypharmacy is a significant concern in patients with heart failure because of the burden of both cardiovascular and noncardiovascular conditions,” the authors wrote. “It is not unusual to have medications ordered and adjusted by different clinicians, many times with minimal consideration or drug-drug or drug-condition interactions, or to have prescriptions filled at different pharmacies.”

The AHA concluded their statement by urging clinicians to use the recommendations to determine the best pharmacologic approach for each patient, and to be aware of potentially hazardous agents that may worsen heart failure.


Page RL, Cheng D, Dow TJ, et al; on behalf of the American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs that may cause or exacerbate heart failure. A scientific statement from the American Heart Association. Circulation. 2016;134(2). doi: 10.1161/CIR.0000000000000426.