Detection of intake of nonsteroidal anti-inflammatory drugs in elderly patients with heart failure : how to ask the patient?

PRINCIPLES: Heart failure hospitalisations may be related to non-steroidal anti-inflammatory drug (NSAID) use. Since NSAIDs are usually prescribed by general practitioners or taken without prescription, their use may be largely underestimated. Therefore, we assessed the impact of a focussed analgesic medication history as compared to a usual medication history on detection of NSAID intake in elderly heart failure patients and the potential effect of medical advice on discontinuation of this therapy in a non-controlled study design. METHODS: A structured and stepwise history of analgesic intake (firstly open questioning about medication intake, secondly with a focus on analgesic intake, finally focussing on behaviour in case of pain) was done in 197 elderly heart failure patients taking part in the TIME-CHF study at baseline and up to 3 follow-up visits. All participants were informed about the potential hazardous effects of NSAIDs and alternative analgesic therapy was proposed in case of NSAID intake. Patients were aged 60 years or older with clinical signs of heart failure NYHA < or =II, elevated NT-BNP, and had been hospitalised due to heart failure within the last year. Details of this study have been described previously. RESULTS: At baseline, 43 patients (22%) were taking NSAID. Almost half (n = 19) taking NSAID reported the use only after specific questioning. Therefore, a focussed analgesic medication history was superior as compared to a usual medication history to detect patients taking NSAIDs (22% vs 12%; p >0.001). After instruction and proposal of alternative analgesic therapy, NSAID intake dropped from 22% to 7% (p >0.001). No risk factor for continuous use was identified. CONCLUSIONS: NSAID use in heart failure patients is relatively common. Specific questioning may help to increase detection of NSAID intake and information on its hazardous effects to decrease NSAID use.