Factors associated with non-steroidal anti-inflammatory drug continuation at discharge in patients with heart failure

Non-steroidal anti-inflammatory drugs (NSAIDs) are potentially inappropriate medications for patients with heart failure (HF) and may cause adverse events through the "triple-whammy" mechanism. We examined the factors associated with the continuation of NSAIDs prescriptions at hospital discharge among patients with HF. Using data from the Japanese Registry of All Cardiac and Vascular Disease and Diagnosis Procedure Combination from April 2020 to March 2023, we analyzed 36,085 patients with HF who received NSAIDs during hospitalization. Patients were categorized as continuing or discontinuing NSAIDs at discharge. Multivariate logistic regression was performed to identify factors associated with continued NSAIDs use, including age, sex, comorbidities, and number of hospital beds. Among patients with HF who were prescribed NSAIDs, 53.4% were concomitantly prescribed a renin angiotensin agent and a diuretic. Rheumatic disease (OR: 3.47; 95% CI 3.16-3.82) showed the strongest association with continued NSAIDs use, while chronic kidney disease (OR: 0.90; 95% CI 0.84-0.96) was negatively associated. Smaller hospital size (< 450 beds) was positively (OR: 1.16; 95% CI 1.10-1.22) correlated with continued NSAIDs prescriptions. A substantial proportion of patients with HF are exposed to triple-whammy drug combinations. These findings can help optimize drug therapy in patients with HF who continue NSAIDs prescriptions.