[OP0203-PC] NEW DATA, NEW PROBLEM; ASSESSING THE PREVALENCE OF NSAID PRESCRIBING IN PRIMARY CARE IN THOSE WITH A BACKGROUND OF ISCHAEMIC HEART DISEASE (IHD) OR RISK FACTORS FOR IHD
C. Orr1, C. O'Connor2, J. Kavanagh2. 1Department of Medicine; 2Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in the treatment of patients in primary care with rheumatic problems (1). The side effect profile and safety of NSAID use has been well reported, but little is known about NSAID treatment duration and its implications for cardiovascular risk (2, 3). New evidence suggests that there is a significant increase in the risk of death or myocardial infarction (MI), in patients with previous MI when given even short term treatment (<1 week) with NSAIDs (4).
Objectives: To identify the number of patients who had a history of IHD, or a significant risk factor for this, who were prescribed NSAIDs in a large primary care facility. We set out to address whether there is a need for prescribing guidelines on the use of NSAIDs in those with IHD.
Methods: The clinics software was interrogated to identify all patients over 50 years, who had been prescribed NSAIDs for any duration, over a two month period in late 2012. Those with documented IHD as well as those with diabetes mellitus and/or hypertension were identified. The indication for treatment and the duration of prescription was recorded.
Results: Approximately 10,000 patients are registered with the practice. 108 patients were prescribed NSAIDs during the period of the study. 39/108 (36%) patients (17 male) had established ischaemic heart disease or risk factors for cardiovascular disease when they were prescribed NSAIDs.
Diclofenac was the NSAID prescribed in 56% of cases.
The mean duration of treatment in the 39 patients was 265 days. 22 of 39 (56%) were prescribed NSAIDs for longer than 1 month, and 6 of the 39 (15%) were prescribed NSAIDs for a year or longer.
Conclusions: The safety of prescribing NSAIDs even for short duration (<1 week) has been challenged (4).
It is disconcerting that diclofenac is the most commonly prescribed NSAID. The increased risk of death and MI becomes apparent immediately with it (4). Diclofenac was prescribed as the preferred agent in 53.9% of (NSAID) prescriptions filled in Ireland in 2010, making it the most commonly prescribed NSAID (5).
Guidelines should be introduced to assist physicians in the safe prescribing of NSAIDs. A critical component of these guidelines should be a recommendation to switch from using diclofenac as the NSAID of choice, to safer alternatives.
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Acknowledgements: Dr Kilian McGrogan
Disclosure of Interest: None Declared
Citation: Ann Rheum Dis 2013;72(Suppl3):121
Session: Abstract Session Primary Care: From epidemiology to effective practice