NSAIDs and heart failure

(1) Case reports and epidemiological studies show that nonsteroidal antiinflammatory drugs (NSAIDs) can cause or worsen heart failure, though this is reversible when the drug is withdrawn. (2) Heart failure can occur or worsen when an NSAID (including aspirin) is combined with a diuretic or angiotensin-converting-enzyme inhibitor (ACE inhibitor). (3) In patients with heart failure, the use of NSAIDs, including "specific" COX 2 inhibitors, should be avoided. If such treatment is unavoidable, patients must be watched closely for clinical worsening.