Scandinavian journal of primary health care · 2014
Ischaemic cardiovascular risk and prescription of non-steroidal anti-inflammatory drugs for musculoskeletal complaints.
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Koffeman Aafke R, Valkhoff Vera E, Jong Geert W'T, Warlé-van Herwaarden Margreet F, Bindels Patrick J E, Sturkenboom Miriam C J M, Luijsterburg Pim A J, Bierma-Zeinstra Sita M A
Аннотация
OBJECTIVE: To determine the influence of ischaemic cardiovascular (CV) risk on prescription of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners (GPs) in patients with musculoskeletal complaints.
DESIGN: Cohort study.
SETTING: A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands.
PATIENTS: A total of 474 201 adults consulting their GP with a new musculoskeletal complaint between 2000 and 2010. Patients were considered at high CV risk if they had a history of myocardial infarction, angina pectoris, stroke, transient ischaemic attack, or peripheral arterial disease, and at low CV risk if they had no CV risk factors.
MAIN OUTCOME MEASURES: Frequency of prescription of non-selective (ns)NSAIDs and selective cyclooxygenase-2 inhibitors (coxibs).
RESULTS: Overall, 24.4% of patients were prescribed an nsNSAID and 1.4% a coxib. Of the 41,483 patients with a high CV risk, 19.9% received an nsNSAID and 2.2% a coxib. These patients were more likely to be prescribed a coxib than patients with a low CV risk (OR 1.9, 95% CI 1.8-2.0). Prescription of nsNSAIDs decreased over time in all risk groups and was lower in patients with a high CV risk than in patients with a low CV risk (OR 0.8, 95% CI 0.7-0.8).
CONCLUSION: Overall, patients with a high CV risk were less likely to be prescribed an NSAID for musculoskeletal complaints than patients with a low CV risk. Nevertheless, one in five high CV risk patients received an NSAID, indicating that there is still room for improvement.
DESIGN: Cohort study.
SETTING: A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands.
PATIENTS: A total of 474 201 adults consulting their GP with a new musculoskeletal complaint between 2000 and 2010. Patients were considered at high CV risk if they had a history of myocardial infarction, angina pectoris, stroke, transient ischaemic attack, or peripheral arterial disease, and at low CV risk if they had no CV risk factors.
MAIN OUTCOME MEASURES: Frequency of prescription of non-selective (ns)NSAIDs and selective cyclooxygenase-2 inhibitors (coxibs).
RESULTS: Overall, 24.4% of patients were prescribed an nsNSAID and 1.4% a coxib. Of the 41,483 patients with a high CV risk, 19.9% received an nsNSAID and 2.2% a coxib. These patients were more likely to be prescribed a coxib than patients with a low CV risk (OR 1.9, 95% CI 1.8-2.0). Prescription of nsNSAIDs decreased over time in all risk groups and was lower in patients with a high CV risk than in patients with a low CV risk (OR 0.8, 95% CI 0.7-0.8).
CONCLUSION: Overall, patients with a high CV risk were less likely to be prescribed an NSAID for musculoskeletal complaints than patients with a low CV risk. Nevertheless, one in five high CV risk patients received an NSAID, indicating that there is still room for improvement.
Предметные рубрики MeSH
AdolescentAdultAgedAnti-Inflammatory Agents, Non-SteroidalCardiovascular DiseasesCohort StudiesContraindicationsCyclooxygenase 2 InhibitorsDrug UtilizationFemaleGastrointestinal DiseasesGeneral PracticeHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisMusculoskeletal DiseasesNetherlandsPharmacoepidemiologyPractice Guidelines as TopicPractice Patterns, Physicians'Renal InsufficiencyRisk FactorsSafety-Based Drug WithdrawalsYoung Adult