Nearly 10 per cent of patients considered to be high risk with existing heart or kidney conditions, who see their family doctor with a musculoskeletal disorder like back pain are prescribed common arthritis medication that could cause them harm or complications, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital (WCH).
Nonsteroidal anti-inflammatory drugs (NSAIDs) represent one of the most common classes of medications used worldwide, with an estimated usage of more than 30 million per day. NSAIDs are commonly prescribed and effective for the treatment of musculoskeletal pain and are commonly used for arthritis. NSAIDs are not recommended for people with heart failure, chronic kidney disease and high blood pressure.
“International guidelines recommend against prescribing NSAIDs to patients with high blood pressure, heart failure and chronic kidney disease but our findings show that these common medications are routinely prescribed with widespread provider-level variation,” says Dr. Sacha Bhatia, lead author on the study and ICES adjunct scientist.
The study published today in JAMA Internal Medicine, used administrative data housed at ICES, and included more than 2.4 million primary care visits for a musculoskeletal disorder involving nearly 815,000 patients aged 65 or older with a history of high blood pressure, heart failure and/or chronic kidney disease from 2012 to 2016.
The researchers found:
- NSAIDs use was observed following 9.3 per cent of visits.
- Prescription NSAID use ranged from 0.9 per cent to 69.2 per cent among more than 7,300 family doctors in Ontario.
- A declining trend in prescription NSAIDs use over time, with an absolute reduction of 2.1 per cent during the study period.
The researchers also found that short term NSAIDs use was not associated with higher risk of adverse outcomes at 30 days.
“Considering present concerns regarding opioid use for non-cancer pain, the ability for physicians to prescribe NSAIDs to manage musculoskeletal pain in the short term could be an important clinical option in this patient population,” adds Bhatia.
“Frequency and impact of prescription nonsteroidal anti-inflammatory drug use among patients with hypertension, heart failure, or chronic kidney disease,” was published today in JAMA Internal Medicine.
Author block: Bouck Z, Mecredy G, Ivers NM, Barua M, Martin D, Austin PC, Tepper J, Bhatia RS.
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
About Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of equitable access, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.
Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.
For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca
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