P-385: Provider awareness of cardiovascular complications associated with non-steroidal anti-inflammatory therapy

Recently published studies suggest a potential drug interaction between cardioprotective doses of aspirin and specific NSAIDs. In addition, cardiovascular complications associated with certain COX-2 inhibitors have been highlighted in the literature and prompted manufacturer action. To determine the awareness of these issues in the general healthcare community, a survey was developed and administered to physicians, pharmacists, and nurse practitioners. Various venues including mail, phone, and personal contact were utilized for data collection. Demographic data collected included age, gender, area of health care, and number of years in practice. Specific survey questions regarding NSAID therapy were designed to determine the clinical impact, assess the significance and influence of potential interactions and complications, and evaluate the influence on individual patient recommendations and management. Over 600 completed surveys were returned. There was no consensus among providers as to the cardiovascular adverse effect profile associated with COX-2 inhibitor therapy. The majority of providers did not know if COX-2 inhibitor cardiovascular complications were a class effect or not (physicians, 57%; pharmacists, 42%; nurse practitioners, 50%). More pharmacists (34%) felt that COX-2 inhibitor complications were a class effect compared with physicians (20%) or nurse practitioners (18%). Of all providers, 59% were more likely to recommend non-selective NSAIDs, while 21% were more likely to recommend celecoxib. Though more comfortable overall with COX-2 inhibitor use compared to non-specific NSAIDs, all providers were less comfortable with concurrent cardioprotective aspirin use as duration of therapy increased (1–2 times/month, 1–2 times/week, scheduled daily dosing). History of gastric events and costs were the primary factors influencing recommendations for specific NSAID use. These survey results indicate a lack of consensus among providers regarding NSAID recommendations as well as both awareness and influence of recent COX-2 inhibitor-associated cardiovascular complications.