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All NSAIDs Harmful in HF — EECC MCQ

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EasyCardiac PharmacologyAll NSAIDs Harmful in HFEECC

A 70-year-old man with HFrEF on GDMT reports that his GP prescribed ibuprofen for knee osteoarthritis. His HF nurse is concerned. What specific NSAIDs are problematic in HF?

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Correct answer: E — ALL NSAIDs (including COX-2 selective inhibitors like celecoxib) are associated with increased HF hospitalisation and should be avoided in HF — the ESC HF Guidelines give this a Class III (harm) recommendation

The ESC HF Guidelines classify ALL NSAIDs (both non-selective and COX-2 selective) as Class III (harm) in heart failure. This includes ibuprofen, naproxen, diclofenac, celecoxib, and etoricoxib. All NSAIDs cause: sodium retention, water retention, increased SVR, blunting of diuretic and ACEi efficacy, and renal vasoconstriction. Observational studies and the PRECISION trial subgroup analyses show increased HF hospitalisation with all NSAIDs. Low-dose topical NSAIDs may have lower systemic absorption but are not completely free of risk. Alternatives: paracetamol (first-line), colchicine (for gout), intra-articular corticosteroid injections, capsaicin cream, physical therapy. Low-dose prednisolone may be preferred over NSAIDs for short courses in acute gout/inflammatory pain.

Reference: ESC (2023): HF Guidelines