In-hospital use of non-steroidal anti-inflammatory drugs in patients with heart failure in academic centers in the United States

Article type: Research Article

Authors: Alvarez, Paulino A.^a | Nguyen, Duc T.^b | Schutt, Robert^c | Ganduglia, Cecilia^d | Estep, Jerry D.^e | Graviss, Edward A.^b | Putney, David^{f; *}

Affiliations: [a] Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA | [b] Houston Methodist Hospital Research Institute, Houston, TX, USA | [c] Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA | [d] University of Texas, School of Public Health, Houston, TX, USA | [e] Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA | [f] Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA

Correspondence: [*] Address for correspondence: David Putney, Department of Pharmacy, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower Suite 1901, Houston, TX 77030, USA. Tel./Fax: +1 713 441 1100; E-mail: [email protected].

Abstract: BACKGROUND: Non-steroidal anti-inflammatory drugs are considered potentially harmful for patients with heart failure. OBJECTIVE: To determine the prevalence of in-hospital NSAID use, their type, associated diagnosis and impact in clinical outcomes among patients with a diagnosis of heart failure. METHODS: The University Health System Consortium Database was used to identify all first hospitalizations with an International Classification of Diseases-9 discharge diagnosis code of systolic heart failure as the primary diagnosis between January 1, 2011, and December 31st 2014. RESULTS: Among 65,902 patients admitted for a primary diagnosis of SHF, 2675 (4.1%) were exposed to NSAID. The most frequent NSAID used was ibuprofen (51.63%), followed by ketorolac (29.38%) naproxen (8.07%) celecoxib (5.61%), and others. On multivariable analyses, the length of stay of patients exposed to NSAID was longer compared to non-exposed (OR: 4.67, p < 0.001, 95% CI 4.10–5.25), but differences in mortality were not statistically different (OR: 0.90, p = 0.476, 95% CI 0.69–1.19). CONCLUSION: The use of NSAID in patients admitted with a primary diagnosis of systolic heart failure was low but was associated with longer length of stay. Further studies are needed to understand the impact of NSAID use in this patient population.

Keywords: Heart failure, non-steroidal anti-inflammatory agents, length of stay

DOI: 10.3233/JRS-170736

Journal: International Journal of Risk & Safety in Medicine, vol. 28, no. 4, pp. 181-188, 2016