Introduction: There is strong evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of heart failure (HF) and mortality in HF patients. Patients admitted with decompensated HF should be screened for NSAID use. Hypothesis: NSAID use in patients admitted with HF is often overlooked due to inadequate screening by clinicians. Methods: We performed a prospective study of all patients admitted to the cardiology service with a primary diagnosis of decompensated HF. All patients were evaluated for enrollment within 48 hours of admission. Exclusion criteria included shock, cardiac arrest, respiratory failure requiring positive pressure ventilation, altered mental status or toxic metabolic encephalopathy, dementia, cognitive deficit, acute gastrointestinal bleed, acute blood loss anemia, and NSAID allergy. Electronic Medical Record review and in-person interviews were performed to determine if subjects had been screened for NSAID use. Positive screening included: documentation of NSAID use or absence of NSAID use in the admission note, medication reconciliation documenting NSAID use, or answering yes to the interview question “Were you asked if you take NSAIDs or over-the-counter pain medication?” Results: The study included 151 subjects (78 men/73 women); mean age 71.7 years. The number of patients who were taking NSAIDs was 34 (22.5%); there was no variation in prevalence between genders. NSAID screening occurred in 15.9% of patients (24/151). Of those taking NSAIDs, 88.3% had not been screened by their providers and 29% had no documented etiology for their HF exacerbation or had documented HF of “unclear etiology.” 56% of patients taking NSAIDs had self-prescribed, while 44% reported prescription by a physician. 82% had been taking NSAIDs regularly for over 1 month. Additionally, of patients on NSAIDs, 53% had coronary artery disease, 56% had hypertension, and 50% had chronic kidney disease. Conclusions: Despite strong evidence that NSAIDs are harmful and contraindicated in many cardiovascular conditions, NSAID use in patients with HF is still prevalent. This study highlights the importance of vigilant screening by clinicians and the need for improved patient education on the risks associated with this class of medication.