Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 11, Number 4, August 2020, pages 239-246

Association of Potentially Inappropriate Medications With All-Cause Mortality in the Elderly Acute Decompensated Heart Failure Patients: Importance of Nonsteroidal Anti-Inflammatory Drug Prescription

**Table 1.** Patient Characteristics (n = 193)
Variables	n (%), mean ± SD
SD: standard deviation; Hb: hemoglobin; Alb: albumin; BUN: blood urea nitrogen; GFR: glomerular filtration rate; HD: hemodialysis; COPD: chronic obstructive pulmonary disease; CS: clinical scenario; LVEF: left ventricular ejection fraction; PIM: potentially inappropriate medication; NSAIDs: non-steroidal anti-inflammatory drugs; PPIs: proton pump inhibitors.
Age (years)	80.7 ± 7.5, median: 81 (65 - 99)
65 - 79	84 (43.5%)
≥ 80	109 (56.5%)
Sex
Male	109 (56.5%)
Female	84 (43.5%)
Clinical laboratory data on admission
Hb (g/dL)	11.2 ± 2.2
Alb (g/dL)	3.4 ± 0.5
BUN (mg/dL)	31.2 ± 18.1
GFR (mL/min/1.73 m²)	42.3 ± 21.3
Type of comorbidity
Hypertension	156 (80.8%)
Dyslipidemia	87 (45.1%)
Diabetes mellitus	82 (42.5%)
Chronic renal disease on HD	7 (3.6%)
Atrial fibrillation/flutter	96 (49.7%)
Coronary artery disease	64 (33.1%)
COPD	15 (7.8%)
Cancer	32 (16.6%)
Etiology
Ischemic heart disease	67 (34.7%)
Hypertensive disease	29 (15.0%)
Valvular disease	31 (16.1%)
Other	66 (34.2%)
CS class
1	83 (43.0%)
2	93 (48.2%)
Other	17 (8.8%)
LVEF
EF < 40%	81 (42.0%)
EF ≥ 40%	95 (49.2%)
Unkown	17 (8.8%)
PIMs
Benzodiazepine	26 (13.5%)
Non-benzodiazepine hypnotics	16 (8.3%)
Sulfonylurea	18 (9.3%)
Thiazolidinediones	3 (1.6%)
Metformin	7 (3.6%)
Steroid	7 (3.6%)
NSAIDs	14 (7.3%)
H₂ antagonists	19 (9.8%)
PPIs	87 (45.1%)
Non-dihydropyridine calcium channel blockers	10 (5.2%)
Pregabalin	2 (1.4%)
Decongestants	0
Medicinal formulations with high sodium content	0
Beta₂-agonists	0
Itraconazole	0

Table 1. Patient Characteristics (n = 193)

Variables

n (%), mean ± SD

SD: standard deviation; Hb: hemoglobin; Alb: albumin; BUN: blood urea nitrogen; GFR: glomerular filtration rate; HD: hemodialysis; COPD: chronic obstructive pulmonary disease; CS: clinical scenario; LVEF: left ventricular ejection fraction; PIM: potentially inappropriate medication; NSAIDs: non-steroidal anti-inflammatory drugs; PPIs: proton pump inhibitors.

Age (years)

80.7 ± 7.5, median: 81 (65 - 99)

65 - 79

84 (43.5%)

≥ 80

109 (56.5%)

Sex

Male

109 (56.5%)

Female

84 (43.5%)

Clinical laboratory data on admission

Hb (g/dL)

11.2 ± 2.2

Alb (g/dL)

3.4 ± 0.5

BUN (mg/dL)

31.2 ± 18.1

GFR (mL/min/1.73 m²)

42.3 ± 21.3

Type of comorbidity

Hypertension

156 (80.8%)

Dyslipidemia

87 (45.1%)

Diabetes mellitus

82 (42.5%)

Chronic renal disease on HD

7 (3.6%)

Atrial fibrillation/flutter

96 (49.7%)

Coronary artery disease

64 (33.1%)

COPD

15 (7.8%)

Cancer

32 (16.6%)

Etiology

Ischemic heart disease

67 (34.7%)

Hypertensive disease

29 (15.0%)

Valvular disease

31 (16.1%)

Other

66 (34.2%)

CS class

83 (43.0%)

93 (48.2%)

Other

17 (8.8%)

LVEF

EF < 40%

81 (42.0%)

EF ≥ 40%

95 (49.2%)

Unkown

17 (8.8%)

PIMs

Benzodiazepine

26 (13.5%)

Non-benzodiazepine hypnotics

16 (8.3%)

Sulfonylurea

18 (9.3%)

Thiazolidinediones

3 (1.6%)

Metformin

7 (3.6%)

Steroid

7 (3.6%)

NSAIDs

14 (7.3%)

H₂ antagonists

19 (9.8%)

PPIs

87 (45.1%)

Non-dihydropyridine calcium channel blockers

10 (5.2%)

Pregabalin

2 (1.4%)

Decongestants

Medicinal formulations with high sodium content

Beta₂-agonists

Itraconazole

**Table 2.** Univariate Analyses of Relationship Between Various Clinical Factors and Mortality (30 Events, n = 193)
Variables	2-year (%)	P value^a
^aLog-rank test. HD: hemodialysis; COPD: chronic obstructive pulmonary disease; SBP: systolic blood pressure; PIM: potentially inappropriate medication; NSAIDs: non-steroidal anti-inflammatory drugs; PPIs: proton pump inhibitors; Hb: hemoglobin; Alb: albumin; eGFR: estimated glomerular filtration rate.
Age ≥ 80 years	20.6	0.378
Male sex	19.2	0.711
Hypertension	15.3	< 0.001
Diabetes mellitus	18.5	0.660
Dyslipidemia	18.8	0.229
Chronic renal disease on HD	35.7	0.156
Atrial fibrillation/flutter	20.2	0.672
Coronary artery disease	28.1	0.420
COPD	43.4	0.028
Cancer	27.1	0.173
SBP < 100 mm Hg	59.2	< 0.001
Number of medication ≥ 6 at admission	25.0	0.045
Common PIMs
Benzodiazepines	13.6	0.970
Other than benzodiazepines	15.4	0.867
Sulfonylurea	13.4	0.482
Thiazolidinediones	0.0	0.415
Metformin	16.7	0.806
Steroid	57.1	0.197
NSAIDs	39.1	0.002
H₂ antagonists	33.9	0.252
PPIs	28.8	0.080
Hb < 12 g/dL	22.7	0.900
Alb < 3.5 g/dL	26.6	0.011
eGFR < 45 mL/min/1.73 m²	21.5	0.323

Table 2. Univariate Analyses of Relationship Between Various Clinical Factors and Mortality (30 Events, n = 193)

Variables

2-year (%)

P value^a

^aLog-rank test. HD: hemodialysis; COPD: chronic obstructive pulmonary disease; SBP: systolic blood pressure; PIM: potentially inappropriate medication; NSAIDs: non-steroidal anti-inflammatory drugs; PPIs: proton pump inhibitors; Hb: hemoglobin; Alb: albumin; eGFR: estimated glomerular filtration rate.

Age ≥ 80 years

20.6

0.378

Male sex

19.2

0.711

Hypertension

15.3

< 0.001

Diabetes mellitus

18.5

0.660

Dyslipidemia

18.8

0.229

Chronic renal disease on HD

35.7

0.156

Atrial fibrillation/flutter

20.2

0.672

Coronary artery disease

28.1

0.420

COPD

43.4

0.028

Cancer

27.1

0.173

SBP < 100 mm Hg

59.2

< 0.001

Number of medication ≥ 6 at admission

25.0

0.045

Common PIMs

Benzodiazepines

13.6

0.970

Other than benzodiazepines

15.4

0.867

Sulfonylurea

13.4

0.482

Thiazolidinediones

0.0

0.415

Metformin

16.7

0.806

Steroid

57.1

0.197

NSAIDs

39.1

0.002

H₂ antagonists

33.9

0.252

PPIs

28.8

0.080

Hb < 12 g/dL

22.7

0.900

Alb < 3.5 g/dL

26.6

0.011

eGFR < 45 mL/min/1.73 m²

21.5

0.323

**Table 3.** Multivariate Analyses of the Relationship Between Various Clinical Factors and Mortality
Prognosis factors	β	HR (95% CI)	P value^a
^aCox regression for mortality. NSAIDs: non-steroidal anti-inflammatory drugs; SBP: systolic blood pressure; COPD: chronic obstructive pulmonary disease; HR: hazard ratio; CI: confidence interval.
NSAIDs, absent vs. present	1.536	4.646 (1.725 - 12.510)	0.002
SBP, <100 mm Hg vs. ≥ 100 mm Hg	1.675	5.341 (2.204 - 12.942)	< 0.001
COPD, absent vs. present	1.349	3.855 (1.417 - 10.489)	0.008

Table 3. Multivariate Analyses of the Relationship Between Various Clinical Factors and Mortality

Prognosis factors

HR (95% CI)

P value^a

^aCox regression for mortality. NSAIDs: non-steroidal anti-inflammatory drugs; SBP: systolic blood pressure; COPD: chronic obstructive pulmonary disease; HR: hazard ratio; CI: confidence interval.

NSAIDs, absent vs. present

1.536

4.646 (1.725 - 12.510)

0.002

SBP, <100 mm Hg vs. ≥ 100 mm Hg

1.675

5.341 (2.204 - 12.942)

< 0.001

COPD, absent vs. present

1.349

3.855 (1.417 - 10.489)

0.008

**Table 4.** Patient Characteristics Comparing Non-NSAID and NSAID Groups
	n (%), mean ± SD, non-NSAIDs (n = 179)	n (%), mean ± SD, NSAIDs (n = 14)	P value
NSAIDs: non-steroidal anti-inflammatory drugs; SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; Alb: albumin; PPIs: proton pump inhibitors.
Age (years)	80.5 ± 7.5	83.8 ± 7.1	0.112
Sex (male)	103 (57.5%)	6 (42.9%)	0.286
Number of medications at admission	6.9 ± 4.0	9.6 ± 4.1	0.013
SBP (mm Hg) at admission	138.4 ± 31.8	139.7 ± 39.1	0.881
DBP (mm Hg) at admission	76.8 ± 22.0	81.2 ± 23.7	0.497
eGFR (mL/min/1.73 m²)	42.2 ± 21.6	43.6 ± 17.3	0.800
Alb (g/dL)	3.5 ± 0.5	3.3 ± 0.4	0.207
PPIs, present	79 (44.1%)	8 (57.1%)	0.346
All-cause mortality	25 (14.0%)	5 (35.7%)	0.031

Table 4. Patient Characteristics Comparing Non-NSAID and NSAID Groups

n (%), mean ± SD, non-NSAIDs (n = 179)

n (%), mean ± SD, NSAIDs (n = 14)

P value

NSAIDs: non-steroidal anti-inflammatory drugs; SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; Alb: albumin; PPIs: proton pump inhibitors.

Age (years)

80.5 ± 7.5

83.8 ± 7.1

0.112

Sex (male)

103 (57.5%)

6 (42.9%)

0.286

Number of medications at admission

6.9 ± 4.0

9.6 ± 4.1

0.013

SBP (mm Hg) at admission

138.4 ± 31.8

139.7 ± 39.1

0.881

DBP (mm Hg) at admission

76.8 ± 22.0

81.2 ± 23.7

0.497

eGFR (mL/min/1.73 m²)

42.2 ± 21.6

43.6 ± 17.3

0.800

Alb (g/dL)

3.5 ± 0.5

3.3 ± 0.4

0.207

PPIs, present

79 (44.1%)

8 (57.1%)

0.346

All-cause mortality

25 (14.0%)

5 (35.7%)

0.031