Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation: A Nationwide Propensity-Matched Study

Christian Madelaire; Gunnar Gislason; Søren L Kristensen; Emil L Fosbøl; Jenny Bjerre; Maria D'Souza; Finn Gustafsson; Lars Kober; Christian Torp-Pedersen; Morten Schou

doi:10.1016/j.jchf.2017.09.021

Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation: A Nationwide Propensity-Matched Study

Christian Madelaire, Gunnar Gislason, Søren L Kristensen, Emil L Fosbøl, Jenny Bjerre, Maria D'Souza, Finn Gustafsson, Lars Kober, Christian Torp-Pedersen, Morten Schou

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

OBJECTIVES: This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.

BACKGROUND: Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease.

METHODS: The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission.

RESULTS: The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result.

CONCLUSIONS: No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality, admission for myocardial infarction, and admission for stroke in patients with HF with no history of atrial fibrillation. Aspirin use was associated with an increased risk of readmission for HF.

Original language	English
Journal	J A C C: Heart Failure
Volume	6
Issue number	2
Pages (from-to)	156-167
ISSN	2213-1779
DOIs	https://doi.org/10.1016/j.jchf.2017.09.021
Publication status	Published - Feb 2018

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10.1016/j.jchf.2017.09.021

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@article{8c5f2dc1b00445d38742d8278496cc33,

title = "Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation: A Nationwide Propensity-Matched Study",

abstract = "OBJECTIVES: This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.BACKGROUND: Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease.METHODS: The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission.RESULTS: The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result.CONCLUSIONS: No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality, admission for myocardial infarction, and admission for stroke in patients with HF with no history of atrial fibrillation. Aspirin use was associated with an increased risk of readmission for HF.",

author = "Christian Madelaire and Gunnar Gislason and Kristensen, {S{\o}ren L} and Fosb{\o}l, {Emil L} and Jenny Bjerre and Maria D'Souza and Finn Gustafsson and Lars Kober and Christian Torp-Pedersen and Morten Schou",

year = "2018",

month = feb,

doi = "10.1016/j.jchf.2017.09.021",

language = "English",

volume = "6",

pages = "156--167",

journal = "J A C C: Heart Failure",

issn = "2213-1779",

publisher = "Elsevier",

number = "2",

}

TY - JOUR

T1 - Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation

T2 - A Nationwide Propensity-Matched Study

AU - Madelaire, Christian

AU - Gislason, Gunnar

AU - Kristensen, Søren L

AU - Fosbøl, Emil L

AU - Bjerre, Jenny

AU - D'Souza, Maria

AU - Gustafsson, Finn

AU - Kober, Lars

AU - Torp-Pedersen, Christian

AU - Schou, Morten

PY - 2018/2

Y1 - 2018/2

N2 - OBJECTIVES: This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.BACKGROUND: Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease.METHODS: The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission.RESULTS: The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result.CONCLUSIONS: No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality, admission for myocardial infarction, and admission for stroke in patients with HF with no history of atrial fibrillation. Aspirin use was associated with an increased risk of readmission for HF.

AB - OBJECTIVES: This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.BACKGROUND: Despite lack of evidence, low-dose aspirin is widely used in patients with HF and sinus rhythm with and without prior ischemic heart disease.METHODS: The study included 12,277 patients with new-onset HF during 2007 to 2012 who had no history of atrial fibrillation. Of 5,450 patients using low-dose aspirin at baseline, 3,840 were propensity matched to non-aspirin users in a 1:1 ratio. Propensity-matched Cox models were calculated with respect to the primary composite outcome of all-cause mortality, myocardial infarction, and stroke and the secondary outcomes of bleeding and HF readmission.RESULTS: The composite outcome occurred in 1,554 (40.5%) patients in the aspirin group and 1,604 (41.8%) patients in the non-aspirin group. Aspirin use was not associated with an altered risk of composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.91 to 1.05), but it was associated with an increased risk of myocardial infarction (HR: 1.34; 95% CI: 1.08 to 1.67), whereas no differences were observed in all-cause mortality and stroke. An increased risk of HF readmission was observed in the aspirin group (HR: 1.25; 95% CI: 1.17 to 1.33). No difference in bleeding was observed. In subgroup analyses on the basis of a history of ischemic heart disease, the results were similar to the main result.CONCLUSIONS: No association was detected between low-dose aspirin use and the composite outcome of all-cause mortality, admission for myocardial infarction, and admission for stroke in patients with HF with no history of atrial fibrillation. Aspirin use was associated with an increased risk of readmission for HF.

U2 - 10.1016/j.jchf.2017.09.021

DO - 10.1016/j.jchf.2017.09.021

M3 - Journal article

C2 - 29413372

SN - 2213-1779

VL - 6

SP - 156

EP - 167

JO - J A C C: Heart Failure

JF - J A C C: Heart Failure

IS - 2

ER -

Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation: A Nationwide Propensity-Matched Study

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