Effectiveness of the CardioPain initiative in reducing inappropriate NSAID prescriptions in pain therapy among high cardiovascular risk patients: an informative Italian survey.

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (COXIBs) may be associated with increased cardiovascular (CV) risk and mortality in CV patients. After the release of Note 66 by Agenzia Italiana del Farmaco (AIFA) to reduce inappropriate prescribing of NSAIDs and COXIBs, the CARDIOPAIN initiative was started in Italy to include such recommendations into the hospital discharge letter of patients with high CV risk. We evaluated the effect of the CARDIOPAIN initiative on the prescription of analgesic drugs by general practitioners (GPs). An online interview was proposed to 414 Italian GPs. A descriptive statistic was reported. Three groups of GPs were identified: those who found the Note 66 recommendations in most hospital discharge letters (the "MOST" group), those who found them in only few cases (the "FEW" group) and those who never found the recommendations (the "NO" group). In patients with high CV risk, the percentage of GPs prescribing NSAIDs as first choice in pain management was lower in the MOST group compared with the "FEW" or "NO" groups. GPs belonging to the "MOST" group prescribed NSAIDs in 28% of cases, compared with 50% of cases observed for GPs belonging to the "NO" group. The more severe the pathology the fewer the NSAID prescriptions, in favor of opioid agents administration. Our results suggest that the inclusion of the AIFA Note 66 in the discharge documents of high CV risk patients may have contributed to lower inappropriate NSAID prescriptions in Italian GPs. Presumably, a wider diffusion of the CARDIOPAIN initiative might improve the prescription appropriateness of analgesic drugs.