Congestive heart failure due to nonsteroidal anti-inflammatory drugs in the elderly

Congestive heart failure in the elderly which might be due to treatment with nonsteroidal anti-inflammatory drugs was studied by means of a questionnaire sent to the participants of a postgraduate course on locomotor disease in the elderly, and also by analysis of the hospital records of 600 elderly subjects diagnosed with congestive heart failure. The questionnaire revealed 22 possible cases, reported by 20 physicians (84 physicians out of 243 responded). In the hospital population five probable cases were detected. Details of these patients are presented. In contrast with findings in the literature, solute retention was in no case the result of kidney function impairment. The specific problems regarding the attribution of this adverse effect are discussed. The results of our study provide further evidence that congestive heart failure due to nonsteroidal anti-inflammatory drug treatment is a probable adverse drug reaction in elderly individuals with or without a history of impaired cardiac performance. It may result from drug toxicity following (relative) overdosing in this age group, from reduced effectiveness of concomitant diuretic treatment or from effects on cardiovascular homoeostasis.