There has been ongoing controversy as to whether
aspirin should be used in patients with chronic
heart failure (CHF). The argument for
aspirin is that many patients have underlying
coronary disease, and
aspirin prevents reinfarction and other vascular events. Arguments against the routine use of
aspirin are that many CHF patients do not have underlying
coronary disease, and that the benefit of
aspirin lessens after the first 6 to 12 months after
infarction. Also, several analyses suggest that
aspirin may actually worsen outcomes in CHF patients, possibly because it inhibits
prostaglandins, with resulting adverse hemodynamic and renal effects. Two recent prospective randomized studies have found that
aspirin is associated with more frequent hospitalizations for worsening
heart failure, although it did not have an adverse effect on vascular events. These results suggest that
aspirin should not be routinely used in CHF patients and be avoided in those with refractory CHF, but that it may be beneficial in patients with recent
infarction or multiple vascular risk factors.