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REVIEW ARTICLES

Drug-induced heart failure

Johannes Feenstra, MD^* , Diederick E. Grobbee, MD, PhD, Willem J. Remme, MD, PhD, FACC and Bruno H. Ch Stricker, MB, PhD^*

^* Inspectorate for Health Care, Drug Safety Unit, The Hague, The Netherlands
Department of Epidemiology and Biostatistics, Pharmacoepidemiology Unit, Erasmus University Medical School, Rotterdam, The Netherlands
Julius Center for Patient Oriented Research, Utrecht University Medical School, Utrecht, The Netherlands
Cardiovascular Research Foundation STICARES, Rotterdam, The Netherlands

Manuscript received August 19, 1998; revised manuscript received November 13, 1998, accepted December 24, 1998.

Reprint requests and correspondence: Dr. B.H.Ch. Stricker, Department of Epidemiology and Biostatistics, Erasmus University Medical School, Dr. Molewaterplein 50, 3000 DR Rotterdam, The Netherlands.
stricker{at}epib.fgg.eur.nl

Heart failure is a clinical syndrome that is predominantly caused by cardiovascular disorders such as coronary heart disease and hypertension. However, several classes of drugs may induce heart failure in patients without concurrent cardiovascular disease or may precipitate the occurrence of heart failure in patients with preexisting left ventricular impairment. We reviewed the literature on drug-induced heart failure, using the MEDLINE database and lateral references. Successively, we discuss the potential role in the occurrence of heart failure of cytostatics, immunomodulating drugs, antidepressants, calcium channel blocking agents, nonsteroidal anti-inflammatory drugs, antiarrhythmics, beta-adrenoceptor blocking agents, anesthetics and some miscellaneous agents. Drug-induced heart failure may play a role in only a minority of the patients presenting with heart failure. Nevertheless, drug-induced heart failure should be regarded as a potentially preventable cause of heart failure, although sometimes other priorities do not offer therapeutic alternatives (e.g., anthracycline-induced cardiomyopathy). The awareness of clinicians of potential adverse effects on cardiac performance by several classes of drugs, particularly in patients with preexisting ventricular dysfunction, may contribute to timely diagnosis and prevention of drug-induced heart failure.

Abbreviations and Acronyms   AUC = area under the curve   CHF = congestive heart failure   COX = cyclooxygenase   DNA = deoxyribonucleic acid   5-FU = 5-fluorouracil   IL-2 = interleukin-2   MDPIT = multicenter diltiazem postinfarction trial   NSAID = nonsteroidal anti-inflammatory drugs   PG = prostaglandin   RNA = ribonucleic acid   SSRI = selective serotonin reuptake inhibitors   TCA = tricyclic antidepressant

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