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Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study.
Eur Heart J Cardiovasc Pharmacother. 2020 Jun 25 [Online ahead of print]EH

Abstract

AIMS

To examine whether prescription patterns complied with recommendations not to use nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular contraindications. Moreover, we examined predictors for initiation and prescriber responsibility.

METHODS AND RESULTS

We identified first-time cardiovascular diseases from medical databases (1996-2017). We assessed standardized prevalence proportions, predictors from logistic regression, and prescriber identifiers. 1-year prevalence of NSAID initiation increased 3.4% from 1996 (19.4%) to 2001 (22.7%) and declined by 2.7% thereafter until 2017 (13.5%). Trends were independent of age, sex, and disease subtype, although larger annual declines occurred for heart failure (3.9%) and ischemic heart disease (3.5%) since 2002. One-year prevalence remained highest among patients with venous thromboembolism (16.6%) and angina (13.8%), and lowest for ST-segment elevation myocardial infarction (7.0%) and heart failure (8.8%). Initiators were predominantly prescribed ibuprofen (59%), diclofenac (23%) and etodolac (6%). Diclofenac and coxib use declined, while ibuprofen and naproxen use increased. Median prescribed pill dose of ibuprofen declined after 2008 from moderate/high (600 mg) to low (400 mg). Treatment duration declined for all NSAIDs, except celecoxib. Rheumatic, obesity, and pain-related conditions predicted NSAID initiation. General practitioners issued 86-91% of all NSAID prescriptions, followed by hospital prescribers (7.3-12%).

CONCLUSIONS

Initiation of NSAIDs in patients with cardiovascular disease declined since 2002. Shorter treatment duration, declining COX-2 inhibition, and increasing use of naproxen and low-dose ibuprofen suggest adherence to guidelines when NSAIDs cannot be avoided. Still, NSAID use remained prevalent despite cardiovascular contraindications, warranting awareness of appropriateness of use among general practitioners in particular.

Authors+Show Affiliations

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32584988

Citation

Schmidt, Morten, and Anton Pottegård. "Prescriber Responsibility, Predictors for Initiation, and 20-year Trends in Use of Non-aspirin Non-steroidal Anti-inflammatory Drugs in Patients With Cardiovascular Contraindications: a Nationwide Cohort Study." European Heart Journal. Cardiovascular Pharmacotherapy, 2020.
Schmidt M, Pottegård A. Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study. Eur Heart J Cardiovasc Pharmacother. 2020.
Schmidt, M., & Pottegård, A. (2020). Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study. European Heart Journal. Cardiovascular Pharmacotherapy. https://doi.org/10.1093/ehjcvp/pvaa073
Schmidt M, Pottegård A. Prescriber Responsibility, Predictors for Initiation, and 20-year Trends in Use of Non-aspirin Non-steroidal Anti-inflammatory Drugs in Patients With Cardiovascular Contraindications: a Nationwide Cohort Study. Eur Heart J Cardiovasc Pharmacother. 2020 Jun 25; PubMed PMID: 32584988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study. AU - Schmidt,Morten, AU - Pottegård,Anton, Y1 - 2020/06/25/ PY - 2020/6/26/entrez PY - 2020/6/26/pubmed PY - 2020/6/26/medline KW - Cardiovascular diseases KW - NSAIDs KW - epidemiology KW - trends JF - European heart journal. Cardiovascular pharmacotherapy JO - Eur Heart J Cardiovasc Pharmacother N2 - AIMS: To examine whether prescription patterns complied with recommendations not to use nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular contraindications. Moreover, we examined predictors for initiation and prescriber responsibility. METHODS AND RESULTS: We identified first-time cardiovascular diseases from medical databases (1996-2017). We assessed standardized prevalence proportions, predictors from logistic regression, and prescriber identifiers. 1-year prevalence of NSAID initiation increased 3.4% from 1996 (19.4%) to 2001 (22.7%) and declined by 2.7% thereafter until 2017 (13.5%). Trends were independent of age, sex, and disease subtype, although larger annual declines occurred for heart failure (3.9%) and ischemic heart disease (3.5%) since 2002. One-year prevalence remained highest among patients with venous thromboembolism (16.6%) and angina (13.8%), and lowest for ST-segment elevation myocardial infarction (7.0%) and heart failure (8.8%). Initiators were predominantly prescribed ibuprofen (59%), diclofenac (23%) and etodolac (6%). Diclofenac and coxib use declined, while ibuprofen and naproxen use increased. Median prescribed pill dose of ibuprofen declined after 2008 from moderate/high (600 mg) to low (400 mg). Treatment duration declined for all NSAIDs, except celecoxib. Rheumatic, obesity, and pain-related conditions predicted NSAID initiation. General practitioners issued 86-91% of all NSAID prescriptions, followed by hospital prescribers (7.3-12%). CONCLUSIONS: Initiation of NSAIDs in patients with cardiovascular disease declined since 2002. Shorter treatment duration, declining COX-2 inhibition, and increasing use of naproxen and low-dose ibuprofen suggest adherence to guidelines when NSAIDs cannot be avoided. Still, NSAID use remained prevalent despite cardiovascular contraindications, warranting awareness of appropriateness of use among general practitioners in particular. SN - 2055-6845 UR - https://www.unboundmedicine.com/medline/citation/32584988/Prescriber_responsibility,_predictors_for_initiation,_and_20-year_trends_in_use_of_non-aspirin_non-steroidal_anti-inflammatory_drugs_in_patients_with_cardiovascular_contraindications:_a_nationwide_cohort_study L2 - https://academic.oup.com/ehjcvp/article-lookup/doi/10.1093/ehjcvp/pvaa073 DB - PRIME DP - Unbound Medicine ER -
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