A person living with heart failure may not think twice about popping an over-the-counter pill for pain, swallowing a vitamin with breakfast or drinking a cup of green tea. But they should. A scientific statement from the American Heart Association (AHA) released in July lists numerous prescription and non-prescription medications and supplements that either are known or suspected to either cause or worsen heart failure or interfere with heart failure drugs.
These medications range from painkillers to surgical anesthetics to common treatments for other heart problems, diabetes, infections, cancer and neurological conditions. The statement is intended as a “comprehensive and accessible source of drugs that may cause or exacerbate heart failure.”
Avoiding these potentially dangerous effects is not always easy for patients. According to studies cited by the AHA, heart failure patients in the U.S. take an average of nearly seven prescription drugs each day. The risk of a bad interaction between drugs rises to 82% for patients taking seven or more drugs, compared to just 13% for two drugs.
The Canadian Institute for Health Information have reported that adverse drug reactions account for nearly 3% of all hospitalizations and that 1 in 200 seniors had a hospitalization related to an adverse drug reaction in 2010-11.
Compounding the risk is that several different doctors or other health care providers may see an individual heart failure patient if they have multiple chronic conditions. Those various health care providers may not know what the others have prescribed.
Drugs and drug interactions can pose a wide range of risks to heart failure patients. They can directly damage heart tissue, disrupt the normal electrical or muscle activity of the heart or raise blood pressure. Some can interfere with the way heart failure medications work or how long they stay active in the body. Some contain a great deal of sodium, which heart failure patients need to avoid.
To help minimize these risks, the statement makes recommendations for both doctors and patients, including:
- Health care providers should collect a comprehensive list of current medications—including over-the-counter drugs and dietary and herbal supplements—from heart failure patients at each and every visit or hospital admission.
- A patient’s health care team should consider appointing a medication “captain” who serves as the contact point when a patient needs to change or add a drug for any condition.
- Doctors should consistently evaluate the potential risks and benefits of each medication a patient is taking and reduce or eliminate those considered optional whenever possible.
- Heart failure patients should talk with their doctor before taking any over-the-counter medication or supplement and should be taught to read the labels of any such product for sodium content.
“My hope is that this statement will be used by health care providers in all medical specialties to educate themselves about drugs that can exacerbate or cause heart failure,” said Robert L. Page II, Pharm.D, chair of the AHA committee that wrote the statement, in an accompanying news release.