Prognostic Role of Contraindicated Drugs in Hospitalized Patients with Decompensated Heart Failure

Due to the ageing population, patients often present to the hospital with a high burden of comorbidities and polypharmacy. For patients admitted with decompensated heart failure (HF), the evidence on the effects of contraindicated drugs on long-term mortality is scarce. Therefore, we aimed to investigate the effect of contraindicated medications on outcomes of patients admitted with decompen-sated HF. We analyzed all consecutive patients from the National Heart Failure Audit admitted to two tertiary centers with acutely de -compensated HF between April 2020 and October 2021. We in-cluded medication classes listed as contraindicated (class III) in the most recent European and American guidelines on the management of HF. The primary outcome measure was in-hospital mortality. The secondary outcome measure was overall mortality. Overall, 716 pa-tients admitted with acute HF were included. One-fifth (n = 156, 21.8%) were on at least one contraindicated medication at admis-sion. The prevalence of comorbidities was comparable between medication groups. During hospitalization, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with increased in - hospital mortality (29% versus 9%, P = 0.013). On multivariable analyses, NSAID use was independently associated with worse in hospital mortality (hazard ratio, 6.86; 95% confidence interval, 1.61-25.5; P = 0.005). However, other contraindicated medications were not associated with adverse outcomes. Postdischarge, the use of erythropoietin during admission was associated with in- creased mortality (54% versus 31%, P = 0.031). NSAID use is asso- ciated with increased in-hospital mortality for patients admitted with acute HF. However, inpatient use of other contraindicated medications was not associated with adverse in-hospital out- comes. Further studies are needed to confirm these results larger and prospective cohorts.