Analgesic use and changes in renal function in patients with heart failure in a real-world setting: a descriptive study using an electronic medical record database

To evaluate the incidence of analgesic use and changes in the estimated glomerular filtration rate (eGFR) of patients with heart failure (HF), with and without analgesic use in a real-world Japanese setting. This retrospective descriptive study collected data from a large electronic medical records database. Between 2012 and 2019, patients aged 18 years or older were included if they were tested for brain natriuretic peptide (BNP) or N-terminal pro-BNP for the first time and were diagnosed with HF within 30 days of the inspection date. We calculated the daily number of patients using any analgesic and described the patient characteristics for each prescribed analgesic, which were classified into acetaminophen (APAP), non-steroidal anti-inflammatory drugs (NSAIDs), selective cyclo‑oxygenase 2 inhibitors, opioids, concomitant users of any analgesic, and non-users. We longitudinally followed the eGFR trend for 2 years using a generalized additive model (GAM) in each group. Among 159,854 eligible patients, 17.8% received analgesics within 90 days of the study entry date. APAP was administered to 51.7% of single analgesic users, followed by NSAIDs (38.7%). GAMs revealed that the eGFR of patients with HF declined only slightly over 2 years, regardless of analgesic use. Even among patients with low renal function at the HF diagnosis, renal function tended to be preserved. This study showed that some patients with HF may need analgesics from the early period after initial HF diagnosis, and that eGFR may be preserved in the long term in real-world practice regardless of analgesic use. • Patients with HF may need analgesics from the early stage of initial HF diagnosis. • APAP may be prescribed more frequently in patients with severe HF. • Renal function was preserved conservatively for a long time in patients with HF in a real-world setting.