Cardiovascular disease and non‐steroidal anti‐inflammatory drug prescribing in the midst of evolving guidelines

Pham, Timothy; Miller, Michael J.; Harrison, Donald L.; Lloyd, Ann E.; Crosby, Kimberly M.; Johnson, Jeremy L.

doi:10.1111/jep.12014

Cited by 12 publications

(10 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The probable explanation for early hyperkalemia resolution was prompt therapeutic interventions with intravenous fluids and stopping NSAIDs. The lower use of NSAIDs causing hyperkalemia in our study (6%) was due to the high prevalence of chronic kidney disease and coronary artery disease in our patients who were less likely to receive NSAIDs [32, 33]. Data to study medication use were recorded in such a way as to reflect the medications the patient was taking immediately prior to the episode of hyperkalemia (36 h).…”

Section: Discussionmentioning

confidence: 99%

Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes

Khanagavi¹,

Gupta²,

Aronow³

et al. 2014

aoms

120

107

View full text Add to dashboard Cite

IntroductionThe aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia.Material and methodsData among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded.ResultsOf 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality.ConclusionsTissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes

Khanagavi¹,

Gupta²,

Aronow³

et al. 2014

aoms

120

107

View full text Add to dashboard Cite

show abstract

“…20,21 Moreover, NSAIDs are commonly prescribed for patients at high risk for experiencing their adverse consequences. 22,23 Recently, a national initiative has been undertaken to also raise NSAID risk understanding and rational use. 24 Published research has demonstrated that physician risk counseling is a strong, positive predictor of NSAID risk awareness.…”

mentioning

confidence: 99%

Screening Questions for Nonsteroidal Anti-inflammatory Drug Risk Knowledge

Bogert¹,

Miller²,

Cobaugh³

et al. 2017

J Patient Saf

Self Cite

View full text Add to dashboard Cite

OBJECTIVE: The aim of this study was to evaluate screening questions for estimating nonsteroidal anti-inflammatory drug (NSAID) risk knowledge. METHODS: Cross-sectional data from a telephone interview of NSAID users 50 years or older from 39 physician practices in Alabama were used. Patient-reported awareness of prescription NSAID risk and health literacy were the independent variables, and a cumulative index score of objectively tested knowledge of 4 prominent NSAID risks was the dependent variable. General linearized latent and mixed model ordered logistic regression was used to estimate associations among the independent variables, covariates, and objectively tested NSAID risk knowledge. Population-averaged probabilities for levels of objectively tested NSAID risk knowledge were subsequently estimated. RESULTS: Subjective awareness of any prescription NSAID risk (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.55-3.74), adequate health literacy (AOR, 1.71; 95% CI, 1.04-2.83), and physician counseling about 1 or more NSAID risks (AOR, 1.69; 95% CI, 1.09-2.61) were significantly and positively associated with NSAID risk knowledge. The probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions was 70% in the absence of any subjective risk awareness and in less than adequate health literacy. Whereas the probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions increased to 86% in the presence of subjective awareness of any prescription NSAID risk and adequate health literacy. CONCLUSIONS: Screening questions for subjective NSAID risk awareness and health literacy are predictive of objectively tested NSAID knowledge and can be used to triage patients as well as subsequently initiate and direct a conversation about NSAID risk

show abstract

“…Internationally, similar concerning trends in NSAID use across settings of care have been reported, but recent data and particularly data from the residential aged care setting are sparse. In the United States, 4% of hospital inpatients with heart failure were using an NSAID during 2011 to 2014, and over one third of outpatient visits that resulted in an NSAID prescription were for patients who had hypertension, congestive heart failure, ischemic heart disease, or cerebrovascular disease during 2005 to 2010 . In Finland, medication claims for NSAIDs were more common among females and people 65 and older during 1997 to 2000 .…”

Section: Introductionmentioning

confidence: 99%

“…In the United States, 4% of hospital inpatients with heart failure were using an NSAID during 2011 to 2014, 15 and over one third of outpatient visits that resulted in an NSAID prescription were for patients who had hypertension, congestive heart failure, ischemic heart disease, or cerebrovascular disease during 2005 to 2010. 16 In Finland, medication claims for NSAIDs were more common among females and people 65 and older during 1997 to 2000. 17 Use of NSAIDs increased during 2002 to 2007 across several central and eastern European countries.…”

Section: Introductionmentioning

confidence: 99%

NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

Lind

Raban

Georgiou

et al. 2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose People in residential aged care are at increased risk of adverse events from nonsteroidal anti‐inflammatory drugs (NSAIDs) due to their age and health status, but little is known about use of NSAIDs in this setting. We aimed to estimate the prevalence of NSAID use by route, differences by high‐risk conditions, prevalence of concurrent proton pump inhibitor (PPI) use, and prevalence of the “triple whammy” combination (oral NSAID, diuretic, and angiotensin‐converting‐enzyme inhibitor or angiotensin receptor antagonist). Methods We conducted a dynamic cohort study using medication administration data from 68 residential aged care facilities (RACFs) during 2014 to 2017. Descriptive statistics and regression were used to estimate the proportion of residents who used NSAIDs, NSAIDs long term, NSAIDs with PPIs, and the triple whammy combination. Results Ten thousand three hundred sixty‐seven residents were included. Two thousand four hundred fourteen (23.3%) used at least one NSAID: 756 (7.3%) used only oral, 1326 (12.8%) used only topical, and 332 (3.2%) used both topical and oral NSAIDs. One thousand five hundred forty two (14.8%) used an NSAID long term, a majority of which only used topical NSAIDs 933/1542 (60.5%). Age, sex, and health status were associated with greater variation in long‐term topical use relative to oral NSAID use. A majority of oral NSAID users concomitantly used a PPI, which varied according to age, sex, and health status. Among residents with any oral NSAID use, 182/1088 (16.7%) had triple whammy medication use. Conclusions Targeted interventions to reduce NSAID use among RACF residents, to reduce triple whammy medication use, and increase PPI use for long‐term oral NSAID users are warranted.

show abstract

Cardiovascular disease and non‐steroidal anti‐inflammatory drug prescribing in the midst of evolving guidelines

Abstract: National prescribing trends suggest partial implementation of AHA guidelines for NSAID prescribing in CVD from 2005 to 2010.

Cited by 12 publications

References 44 publications

Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes

Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes

Screening Questions for Nonsteroidal Anti-inflammatory Drug Risk Knowledge

NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

Contact Info

Product

Resources

About