Bouck Z, et al. - In this retrospective cohort study, researchers investigated the frequency and associations of nonsteroidal anti-inflammatory drug (NSAID) use among patients with hypertension, heart failure (HF), or chronic kidney disease (CKD). According to findings, in high-risk patients visiting primary care, NSAIDs were frequently prescribed. The investigators also noted widespread physician-level variation. Findings revealed no link between prescription NSAID use and increased risk of short-term, safety-related outcomes.

Methods

• A cohort of primary care visits for a musculoskeletal disorder involving patients aged ≥ 65 years with a history of hypertension, HF, or CKD was created between April 1, 2012, and March 31, 2016, in Ontario, Canada, by linking administrative claims databases.
• Definition of prescription NSAID use was ≥ 1 patient-level Ontario Drug Benefit claim for a prescription NSAID dispensing within 7 days after a visit.
• Between 8 and 37 days after each visit, multiple CV and renal safety-related outcomes were determined, including cardiac complications (any emergency department visit or hospitalization for CV disease), renal complications (any hospitalization for hyperkalemia, acute kidney injury, or dialysis), and death.

Results

• Of 2,415,291 musculoskeletal-related primary care visits by 814,049 older adults with hypertension, HF, or CKD, prescription NSAID use during follow up was reported among 224,825 (9.3%).
• Among 7,365 primary care physicians, 11.0% median physician-level prescribing rate was reported.
• Within a sample of 35,552 matched patient pairs, each consisting of an exposed and non-exposed patient matched on the logit of their propensity score for prescription NSAID use (exposure), cardiac complications (288 [0.8%] vs 279 [0.8%]), renal complications (34 [0.1%] vs 33 [0.1%]), and death (27 [0.1%] vs 30 [0.1%]) occurred at similar rates.
• As per observations, CV and renal-safety related outcomes did not differ between exposed patients (308 [0.9%]) and non-exposed patients (300 [0.8%]).