Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Tulsa, Oklahoma, USA.
J Eval Clin Pract. 2013 Dec;19(6):1026-34. doi: 10.1111/jep.12014. Epub 2012 Nov 19.
RATIONALE, AIMS AND OBJECTIVES: Responding to safety concerns, the American Heart Association (AHA) published guidelines for non-steroidal anti-inflammatory drug (NSAID) use in patients with pre-existing cardiovascular disease (CVD) during 2005 and revised them in 2007. In the revision, a stepped approach to pain management recommended non-selective NSAIDs over highly selective NSAIDs. This research evaluated NSAID prescribing during and after guideline dissemination.
A cross-sectional sample of 8666 adult, community-based practice visits with one NSAID prescription representing approximately 305 million visits from the National Ambulatory Medical Care Survey (NAMCS) from 2005 to 2010 was studied. Multivariable logistic regression controlling for patient, provider and visit characteristics assessed the associations between diagnosis of CVD and NSAID type prescribed during each calendar year. Visits were stratified by arthritis diagnosis to model short-term/intermittent and long-term NSAID use.
Approximately one-third (36.8%) of visits involving a NSAID prescription included at least one of four diagnoses for CVD (i.e. hypertension, congestive heart failure, ischaemic heart disease or cerebrovascular disease). Visits involving a CVD diagnosis had increased odds of a prescription for celecoxib, a highly selective NSAIDs, overall [adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.06-1.57] and in the subgroup of visits without an arthritis diagnosis (AOR = 1.45, 95% CI: 1.11-1.89). Results were not statistically significant for visits with an arthritis diagnosis (AOR = 1.10, 95% CI: 0.47-2.57). When analysed by year, the relationship was statistically significant in 2005 and 2006, but not statistically significant in each subsequent year.
National prescribing trends suggest partial implementation of AHA guidelines for NSAID prescribing in CVD from 2005 to 2010.
背景、目的和目标：针对安全性问题，美国心脏协会（AHA）在 2005 年发布了针对存在心血管疾病（CVD）的患者使用非甾体抗炎药（NSAID）的指南，并在 2007 年进行了修订。在修订版中，推荐采用阶梯式疼痛管理方法，将非选择性 NSAID 优先于高度选择性 NSAID。本研究评估了指南发布后的 NSAID 处方情况。
从 2005 年至 2010 年，我们对来自国家门诊医疗调查（NAMCS）的 8666 例成年社区实践就诊者的 NSAID 处方进行了横断面抽样研究，每例 NSAID 处方代表约 3.05 亿次就诊。采用多变量逻辑回归控制患者、医生和就诊特征，评估了 CVD 诊断与 NSAID 类型之间的关联。根据关节炎诊断对就诊进行分层，以建立短期/间歇性和长期 NSAID 使用模型。
约有三分之一（36.8%）的 NSAID 处方涉及至少四种 CVD 诊断之一（即高血压、充血性心力衰竭、缺血性心脏病或脑血管疾病）。涉及 CVD 诊断的就诊者，使用塞来昔布（一种高度选择性 NSAID）的可能性更高，整体而言[校正比值比（AOR）=1.29，95%置信区间（CI）：1.06-1.57]，且在没有关节炎诊断的就诊者亚组中（AOR=1.45，95%CI：1.11-1.89）。对于有关节炎诊断的就诊者，结果无统计学意义（AOR=1.10，95%CI：0.47-2.57）。按年份分析，2005 年和 2006 年的关系具有统计学意义，但在随后的每一年均无统计学意义。
从 2005 年至 2010 年，全国处方趋势表明，AHA 关于 CVD 中 NSAID 处方的指南部分得到了执行。
