NSAIDS ASSOCIATED WITH INCREASED RISK OF CONGESTIVE-HEART-FAILURE IN ELDERLY PATIENTS TAKING DIURETICS

Background: Both diuretics and nonsteroidal antiinflammatory drugs (NS AIDs) are widely used, in particular among the elderly. The use of NSA IDs may decrease the efficacy of diuretics and induce congestive heart failure (CHF) in patients treated with diuretics. Objective: To inves tigate the risk of CHF associated with combined use of diuretics and N SAIDs in patients older than 55 years. Methods: We conducted a study i n a base cohort of 10 519 recipients of diuretics and NSAIDs identifie d in the PHARMO database during the period from 1986 through 1992. The incidence density of hospitalizations for CHF during exposure to both diuretics and NSAIDs (index) was compared with that during exposure t o diuretics only (reference). Results: We found an overall increased r isk of hospitalization for CHF during periods of concomitant use of di uretics and NSAIDs compared with use of diuretics only (crude relative risk, 2.2; 95% confidence interval, 1.7-2.9). After adjusting for cof actors including age, sex, history of hospitalization, and drug use, a 2-fold increased risk remained (relative risk, 1.8; 95% confidence in terval, 1.4-2.4). Conclusion: Use of NSAIDs in elderly patients taking diuretics is associated with a 2-fold increased risk of hospitalizati on for CHF, especially in those with existing serious CHF.