there is evidence that people with heart failure who took NSAIDs were at substantially greater risk of death or being admitted to hospital for treatment of heart failure or MI, than non-users
risk was greater with higher doses, and diclofenac was associated with a particularly high risk
Danish observational study examined the use of NSAIDs in patients with heart failure
diclofenac use was associated with an increased risk of death from all causes, greatest at doses more than 100mg/day
also associated with an increased risk of re-admission for heart failure and, at doses greater than 100mg/day, admission for myocardial infarction (MI)
celecoxib was associated with an increased risk of death, plus an increased risk of re-admission for heart failure and admission for MI
risk was greater at higher doses
ibuprofen
at doses of 1200mg/day or less, ibuprofen did not statistically significantly increase the risk of death, but it did at higher doses
at all doses, ibuprofen increased the risk of re-admission for heart failure and admission for MI
naproxen
not associated with a statistically significantly increased risk of death when used at doses of 500mg/day or less, but it did increase the risk at higher doses
was not associated with a statistically significantly increased risk of re-admission for heart failure
daily doses of naproxen at 500mg or less were associated with an increased risk of admission for MI, but at higher doses the observed increased risk was not statistically significant
a review suggests that health professionals should consider the cardiovascular (CV) risk of NSAIDs and use them only when essential in people with heart failure (2)
all NSAIDs are contraindicated in people with severe heart failure
if an NSAID is essential, these data indicate the first choice drug is ibuprofen at 1200mg/day or less, with naproxen probably second choice at daily doses of 500mg/day or less if possible
co-prescription with a PPI to manage gastrointestinal side effects and guard against ulceration may also be indicated
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