Short Attention Span Summary
NSAIDs + CHF = Fail
NSAIDs were associated with an increased risk of admission for heart failure. Odds of hospital admission for heart failure went up 19% if any NSAIDs were used; 83% with ketorolac; 100% with high-dose (defined as more than 2 daily doses) ketorolac or several other NSAIDs. Most patients can tolerate NSAIDs, but some are vulnerable. Patients with CHF may not realize that using NSAIDs may worsen their condition, but we as clinicians must.
NSAIDs increase the risk of hospitalization for heart failure. Avoid these drugs in at-risk patients.
BMJ. 2016 Sep 28;354:i4857. doi: 10.1136/bmj.i4857.
Arfè A1, Scotti L1, Varas-Lorenzo C2, Nicotra F1, Zambon A1, Kollhorst B3, Schink T3, Garbe E3, Herings R4, Straatman H4, Schade R5, Villa M6, Lucchi S6, Valkhoff V5, Romio S5, Thiessard F7, Schuemie M5, Pariente A7, Sturkenboom M5, Corrao G8; Safety of Non-steroidal Anti-inflammatory Drugs (SOS) Project Consortium.
- 1Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy.
- 2RTI Health Solutions, Barcelona, Spain.
- 3Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany.
- 4PHARMO Institute, Utrecht, Netherlands.
- 5Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, Netherlands.
- 6Local Health Authority ASL Cremona, Cremona, Italy.
- 7University of Bordeaux Segalen, Bordeaux, France.
- 8Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy firstname.lastname@example.org.
To investigate the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) and estimate the risk of hospital admission for heart failure with use of individual NSAIDs.
Nested case-control study.
Five population based healthcare databases from four European countries (the Netherlands, Italy, Germany, and the United Kingdom).
Adult individuals (age ≥18 years) who started NSAID treatment in 2000-10. Overall, 92 163 hospital admissions for heart failure were identified and matched with 8 246 403 controls (matched via risk set sampling according to age, sex, year of cohort entry).
MAIN OUTCOME MEASURE:
Association between risk of hospital admission for heart failure and use of 27 individual NSAIDs, including 23 traditional NSAIDs and four selective COX 2 inhibitors. Associations were assessed by multivariable conditional logistic regression models. The dose-response relation between NSAID use and heart failure risk was also assessed.
Current use of any NSAID (use in preceding 14 days) was found to be associated with a 19% increase of risk of hospital admission for heart failure (adjusted odds ratio 1.19; 95% confidence interval 1.17 to 1.22), compared with past use of any NSAIDs (use >183 days in the past). Risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). Odds ratios ranged from 1.16 (95% confidence interval 1.07 to 1.27) for naproxen to 1.83 (1.66 to 2.02) for ketorolac. Risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses (≥2 defined daily dose equivalents), although some confidence intervals were wide. Even medium doses (0.9-1.2 defined daily dose equivalents) of indomethacin and etoricoxib were associated with increased risk. There was no evidence that celecoxib increased the risk of admission for heart failure at commonly used doses.
The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent. This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.
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PMID: 27682515 [PubMed - as supplied by publisher]