TNF and heart failure: TNF-alpha inhibition may be associated with exacerbation of heart failure (HF), according to randomized clinical trials of TNF-alpha inhibitors as a potential therapy for improving cardiac function in HF, whose post-marketing surveillance data collected by the FDA showed exactly the opposite: increased mortality with deterioration of cardiac function in 2001, worsening CHF, with 38 patients developing HF and nine with worsening of previous HF.5