Current guidelines advise against the use of NSAIDs in patients with chronic heart failure (CHF) due to the increased risk of fluid retention. However, many NSAIDS are available over the counter (OTC), and patients obtaining them in this manner may be putting themselves at increased risk of myocardial infarction or worsening heart failure.
Gislason et al. used the Danish National Patient Registry to identify 107,092 patients aged over 30 who had survived a first hospitalization for heart failure. Then, using the national prescription registry, all claimed prescriptions of NSAIDs were identified.
A total of 36,354 patients (33.9%) claimed at least one NSAID prescription after discharge. The hazard ratio (HR) for death was 1.70 for rofecoxib, 1.75 for celecoxib, 1.31 for ibuprofen, 2.08 for diclofenac, 1.22 for naproxen and 1.28 for all other NSAIDs. A dose dependent increase in risk of death and hospitalization due to heart failure or myocardial infarction was also noted for each NSAID.
Although observational, this study underlines that NSAIDs are still frequently used by heart failure patients, and that the consequences are not benign. No data were available on whether the majority of prescriptions came from physicians or were bought OTC, but the authors suggest that all NSAIDs should be available only on prescription.
· Gislason GH, Rasmussen JN, Abildstrom SZ, et al. Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med2009; 169:141-149