From the Guidelines
Cardizem (diltiazem) should be avoided in patients with diastolic heart failure due to its negative inotropic properties, which can worsen heart failure symptoms. For patients with diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), the use of Cardizem requires careful consideration of the potential risks and benefits. According to the 2016 American Heart Association scientific statement 1, nondihydropyridine calcium channel blockers like diltiazem and verapamil should be avoided in patients with heart failure with reduced ejection fraction (HFrEF) due to their negative inotropic effects. Similarly, the 2012 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure recommend discontinuing calcium-channel blockers unless absolutely necessary, citing their potential harm due to negative inotropic effects 1.
When considering the management of diastolic heart failure, it is essential to prioritize medications that improve symptoms and quality of life while minimizing the risk of adverse effects. The use of Cardizem may help control heart rate and blood pressure, potentially improving symptoms by allowing more time for ventricular filling. However, its negative inotropic effects could outweigh these benefits, leading to worsening heart failure symptoms such as fluid retention, shortness of breath, or increased fatigue.
Key considerations for the management of diastolic heart failure include:
- Controlling blood pressure and heart rate to reduce the oxygen demand of the heart and improve diastolic filling time
- Monitoring for signs of fluid retention, worsening shortness of breath, or increased fatigue
- Implementing lifestyle modifications such as sodium restriction and regular physical activity as tolerated
- Using medications that have been shown to improve outcomes in heart failure, such as ACE inhibitors, beta-blockers, and diuretics, under the guidance of a healthcare provider.
In the context of diastolic heart failure, the potential risks associated with Cardizem use, as highlighted by the available evidence 1, suggest that alternative treatment options should be prioritized to optimize patient outcomes and minimize morbidity, mortality, and impact on quality of life.
From the FDA Drug Label
Although diltiazem has a negative inotropic effect in isolated animal tissue preparations, hemodynamic studies in humans with normal ventricular function have not shown a reduction in cardiac index nor consistent negative effects on contractility (dP/dt) Experience with the use of diltiazem hydrochloride alone or in combination with beta-blockers in patients with impaired ventricular function is very limited. Caution should be exercised when using the drug in such patients.
The safety of diltiazem in diastolic heart failure is not directly established, as the available data are limited to patients with normal ventricular function or impaired ventricular function in general, without specific information on diastolic heart failure. Therefore, caution should be exercised when using diltiazem in patients with diastolic heart failure, due to its potential negative inotropic effect and limited experience in patients with impaired ventricular function 2.
From the Research
Safety of Cardizem in Diastolic Heart Failure
- The safety of Cardizem (diltiazem) in diastolic heart failure is not well established, with limited studies specifically addressing its use in this condition 3, 4.
- Diltiazem is a calcium channel antagonist that has been used to treat various cardiovascular disorders, including hypertension and angina pectoris 5.
- However, its use in heart failure, particularly diastolic heart failure, is not recommended due to the potential for negative inotropic effects and worsening of heart failure symptoms 4.
- Studies have shown that calcium channel antagonists, including diltiazem, may have detrimental effects on survival and cardiovascular events in patients with heart failure 3, 4.
- There is no specific indication for Cardizem in patients with diastolic heart failure, and its use should be approached with caution 3, 4.
- Other calcium channel antagonists, such as amlodipine, may be considered for the management of hypertension or coronary artery disease in patients with heart failure, but their use in diastolic heart failure is not well established 3, 6.
- Current treatment options for diastolic heart failure are limited, and more research is needed to develop effective therapies for this condition 7.