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7.3.6. Other Drug Treatment
COR LOE
Recommendations
2b B-R 1. In patients with HF class II to IV symptoms, omega-3
polyunsaturated fatty acid (PUFA) supplementation may be
reasonable to use as adjunctive therapy to reduce mortality
and cardiovascular hospitalizations.
2b B-R 2. In patients with HF who experience hyperkalemia (serum
potassium level ≥5.5 mEq/L) while taking a renin-
angiotensin-aldosterone system inhibitor (RAASi), the
effectiveness of potassium binders (patiromer, sodium
zirconium cyclosilicate) to improve outcomes by facilitating
continuation of RAASi therapy is uncertain.
3: No
Benefit
B-R 3. In patients with chronic HFrEF without a specific indication
(e.g., venous thromboembolism [VTE], AF, a previous
thromboembolic event, or a cardioembolic source),
anticoagulation is not recommended.
7.3.7. Drugs of Unproven Value or That May Worsen HF
COR LOE
Recommendations
3: No
Benefit
A 1. In patients with HFrEF, dihydropyridine calcium channel-
blocking drugs are not recommended treatment for HF.
3: No
benefit
B-R 2. In patients with HFrEF, vitamins, nutritional supplements,
and hormonal therapy are not recommended other than to
correct specific deficiencies.
3: Harm A 3. In patients with HFrEF, nondihydropyridine calcium channel-
blocking drugs are not recommended.
3: Harm A 4. In patients with HFrEF, class IC antiarrhythmic medications
and dronedarone may increase the risk of mortality.
3: Harm A 5. In patients with HFrEF, thiazolidinediones increase the risk of
worsening HF symptoms and hospitalizations.
3: Harm B-R 6. In patients with type 2 diabetes and high cardiovascular risk,
the dipeptidyl peptidase-4 (DPP-4) inhibitors saxagliptin and
alogliptin increase the risk of HF hospitalization and should
be avoided in patients with HF.
3: Harm B-NR 7. In patients with HFrEF, NSAIDs worsen HF symptoms and
should be avoided or withdrawn whenever possible.
