The European Society of Cardiology (ESC) recently published the 2012 Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure (HF). The editors of MPR have provided a comprehensive summary of the 2012 guidelines. Part 2 of this summary covers the treatments that are not recommended as they may cause harm. Part 1 reviewed recommended pharmacological treatments for HF.

TREATMENTS TO AVOID – BELIEVED TO CAUSE HARM IN SYMPTOMATIC NYHA CLASS II-IV SYSTOLIC HEART FAILURE (HF)

  • Thiazolidinediones (glitazones) should NOT be used as they cause worsening HF and increase the risk of HF hospitalization (Class III; Level A recommendation)
  • Most calcium channel blockers (except amlodipine and felodipine) have a negative inotropic effect and should not be used as they can worsen HF (Class III; Level B recommendation)
  • Avoid NSAIDs and COX-2 inhibitors, if possible, as they may cause sodium and water retention, worsening renal function and HF (Class III; Level B recommendation)
  • The addition of an ARB (or renin inhibitor) to an ACE inhibitor + mineralocorticoid receotir antagonist (MRA) is NOT recommended because of the risk of renal dysfunction and hyperkalemia (Class III; Level C recommendation)

TREATMENTS NOT RECOMMENDED – UNPROVEN BENEFIT

HMG-CoA Reductase Inhibitors (Statins)

  • Current evidence does not support the initiation of statins in most patients with chronic HF, despite the large quantity of evidence supporting statins in patients with arteriosclerotic disease and other cardiovascular diseases
  • Most trials excluded patients with HF because it was uncertain that they would benefit
  • Two recent trials of statins in patients with chronic HF did not demonstrate convincing evidence of benefit (although there was little evidence of harm)

Renin Inhibitors

  • Aliskiren is currently being evaluated in two morbidity-mortality randomized controlled trials
      • It is not presently recommended as an alternative to an ACEI or ARB


Oral Anticoagulants

  • Other than in patients with AF (both HF-REF and HF-PEF), there is no evidence that an oral anticoagulant reduces mortality-morbidity compared with placebo or aspirin

REFERENCE

European Society of Cardiology. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Available at: http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/Guidelines-Acute%20and%20Chronic-HF-FT.pdf. Accessed on May 29, 2012.