Log in to MyACC
NSAID Use for Musculoskeletal Disorder in Patients With HTN, HF, or CKD
Study Questions:
What is the frequency of nonsteroidal anti-inflammatory drug (NSAID) use in patients with hypertension (HTN), heart failure (HF), or chronic kidney disease (CKD), and are there short-term safety-related outcomes?
Methods:
Population-based administrative health care databases were used for this retrospective cohort study. Visits to primary care physicians for musculoskeletal disorders (fractures/dislocations, strains/sprains, arthritis, etc.) were identified from Ontario Health Insurance Plan claims between April 1, 2012, and March 31, 2016. Ontario residents 65 years and older with diagnoses of HTN, HF, or CKD with prescription drug coverage (at least in part) by Ontario Drug Benefit were included. Dispensing of a prescription for NSAID within 7 days after visit with one patient level Ontario Drug Benefit claim defined the prescription NSAID use. Over-the-counter NSAIDs, aspirin, and topical NSAIDs were excluded. Cardiovascular-related (hospitalization or emergency department visit for HTN, HF, hypertensive CKD, myocardial infarction, stroke, etc.) or renal-related (hospitalization for hyperkalemia, acute kidney injury, or acute dialysis) safety outcomes within 8-37 days post-visit associated with prescription NSAID use were examined. Cardiovascular or renal safety-related outcomes within 7 days of their visit were excluded.
Results:
Of 2,415,291 primary care visits for musculoskeletal disorders identified, there were 814,049 patients (mean age 75, 61.1% female) with HTN, HF, or CKD. Of those visits, 224,825 (9.3%) included prescription NSAID use. From these patient visits, NSAID use post-visit was higher in those with HTN (204,202 [90.8%]) or those with previous NSAID use (75,544 [33.6%]). NSAID use was observed post-HF visit (4641 [2.1%]), and post-visit in patients with CKD (3560 [1.6%]). Traditional NSAIDS were more commonly dispensed than selective cyclooxygenase 2 inhibitors (82.7% vs. 18.3%). For safety-related outcomes, a sample of 35,552 exposed and non-exposed patient pairs were matched. The following were similar for patients with or without NSAID use: 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%]).
Conclusions:
Of primary care visits for musculoskeletal disorder in older adults at high risk, NSAID prescription use occurred after almost 10% of visits. Short-term safety-related outcomes were found to be no different between NSAID users and non-users. More studies are needed to optimally manage musculoskeletal pain for this patient population.
Perspective:
This study examined NSAID use at 7 days for patients with HTN, HF, or CKD and potential for association with short-term safety. Patients with prior NSAID use, HTN, and of younger age were more likely to have NSAIDS prescribed, whereas patients with CKD, HF, hospitalization in the last year, or prior opioid use were less likely to have NSAIDs prescribed. NSAID users in this study had less severe disease and were healthier than non-NSAID users. NSAID use was likely underestimated due to inability to capture over-the-counter use. Further studies of more ideal therapies for musculoskeletal pain in these patients are needed.
Keywords: Anti-Inflammatory Agents, Non-Steroidal, Musculoskeletal Pain, Heart Failure, Renal Insufficiency, Chronic, Hypertension, Primary Health Care, Physicians, Primary Care, Hospitalization, Emergency Service, Hospital, Hyperkalemia, Renal Dialysis, Acute Kidney Injury, Aspirin, Cyclooxygenase 2 Inhibitors
< Back to Listings
