GP database study raises questions about NSAIDS

A database of anonymised GP records run by the University of Nottingham and EMIS has provided the data for a study published this week saying that Ibuprofen and other commonly used painkillers for treating inflammation may increase the risk of heart attack.

The study, which appeared in this week’s edition of the BMJ, said patients should not stop taking the drugs involved – non-steroidal anti-inflammatory drugs (NSAIDS) – but further investigation into these treatments is needed.

Researchers identified 9,218 patients across England, Scotland and Wales who suffered a heart attack for the first time over a four year period. Patients ranged in age from 25 to 100.

The data came from the QRESEARCH database, run by the University of Nottingham in collaboration with the primary care IT software provider EMIS. Set up two years ago as a non-for profit organisation, QRESEARCH automatically collects real-time anonymised clinical data from 500 GP practices across England and Scotland, representing around 3.5 million patients.

Practices that provide automatic updates get feedback on their performance indicators. "All data is anonymised on both a patient and practice level and is strongly encrypted," explained Dr David Stables medical director for EMIS.

"QRESEARCH provides an anonymised upload of patient data from practice systems which is fed into a central database," said Dr Stables. Only fully coded patient data is extracted.

He added that although InPractice Systems and iSOFT ran similar databases the key feature of the QRESEARCH system is that it was run by a non-for profit organisation, which didn’t sell the data on. To get access to the data researchers have to first go through ethics committee approval. "To get access to data got to get ethical approval, this includes work done by staff at the University of Nottingham".

In the NSAIDS study Nottingham University Researchers tracked whether patients had been prescribed NSAIDS. NSAIDS are commonly prescribed to relieve inflammation and pain, and include ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib, plus a host of other less commonly prescribed anti-inflammatories.

The findings were adjusted to allow for several other heart attack risk factors – including age, obesity, and smoking habits. Importantly, they also adjusted for whether the patient already suffered from heart disease, or whether they were being prescribed aspirin.

Researchers found that for those prescribed NSAIDS in the three months just before the heart attack, the risk increased compared with those who had not taken these drugs in the previous three years. For ibuprofen, the risk increased by almost a quarter (24%), and for diclofenac it rose by over a half (55%).