Heart 2006 May 22; (Read article online)

Huerta C, Varas-Lorenzo C, Castellsague J, García Rodríguez LA

Objetives To estimate the risk of first hospital admission for heart failure (HF) associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Background Observational studies have shown that NSAID use increased the risk of incident HF and hospitalization for HF, mostly among patients with previous heart disease, as well as the risk of a HF relapse. Methods We conducted a cohort study with a nested case-control analysis using the U.K General Practice Research Database. Overall, 1,396 cases of first hospital admission for non fatal HF were identified (January 1997 to December 2000) and compared with a random sample of 5,000 controls. Results The incidence rate was 2.7 per 1,000 person-years. Prior clinical diagnosis of HF was the main independent risk factor triggering a first HF hospitalization (Relative Risk(RR)7.3;95%CI 6.3-8.8). The risk of a first hospital admission for HF associated with current use of NSAIDs was 1.3(95%CI 1.1-1.6) after controlling for major confounding factors. No effects of dose and duration were found. The RR in current users of NSAIDs with prior HF was 8.6(95%CI 5.3-13.8) compared to patients who did not use NSAIDs and without prior clinical diagnosis of HF. Conclusion Use of NSAIDs was associated with a small risk increase of first hospitalization for HF. In patients with prior clinical diagnosis of HF, the use of NSAIDs might lead to worsening of pre-existing HF that triggers their hospital admission. This increased risk, although small, may result in considerable public health impact, particularly among the elderly.