NSAID Contraindication in HF — EECC MCQ

Correct answer: C — NSAIDs (ibuprofen, naproxen, diclofenac) should be avoided in HF — they cause sodium and water retention, increase SVR, blunt the effect of diuretics and RAAS inhibitors, and increase HF hospitalisation and mortality

NSAIDs are contraindicated (Class III) in heart failure. Mechanisms of harm include: (1) sodium and water retention (inhibiting prostaglandin-mediated renal sodium excretion and free water clearance); (2) increased systemic vascular resistance; (3) blunting of diuretic efficacy (prostaglandins mediate renal tubular response to loop diuretics); (4) counteracting ACEi/ARB efficacy (prostaglandins contribute to the afferent arteriolar vasodilation that ACEi enhance); (5) increased risk of AKI in CKD patients. The ESC HF Guidelines and NICE guidelines explicitly warn against NSAID use in HF. For gout in HF: colchicine is the preferred acute treatment (with dose adjustment for renal function); corticosteroids (short course) are an alternative; allopurinol or febuxostat for prophylaxis. Paracetamol is generally safe for mild pain.

Reference: ESC (2023): HF Guidelines