Warfarin use and outcomes in patients with advanced chronic systolic heart failure without atrial fibrillation, prior thromboembolic events, or prosthetic valves.

Pubmed ID: 21185004

Pubmed Central ID: PMC3053576

Journal: The American journal of cardiology

Publication Date: Feb. 15, 2011

Affiliation: University of Alabama at Birmingham, USA.

MeSH Terms: Humans, Male, Adult, Female, Case-Control Studies, Algorithms, Middle Aged, Proportional Hazards Models, Atrial Fibrillation, Chronic Disease, Regression Analysis, Treatment Outcome, Confidence Intervals, Follow-Up Studies, Kaplan-Meier Estimate, Anticoagulants, Warfarin, Heart Failure, Systolic, Heart Valve Prosthesis, Thromboembolism

Grants: R01 HL085561, R01-HL085561, R01 HL085561-03, R01 HL097047, R01 HL097047-01, R01-HL097047

Authors: Ahmed MI, White M, Love TE, Aban I, Aronow WS, Ahmed A, Mujib M, Desai RV, Feller MA, Deedwania P, Fonarow G, Rahman AA

Cite As: Mujib M, Rahman AA, Desai RV, Ahmed MI, Feller MA, Aban I, Love TE, White M, Deedwania P, Aronow WS, Fonarow G, Ahmed A. Warfarin use and outcomes in patients with advanced chronic systolic heart failure without atrial fibrillation, prior thromboembolic events, or prosthetic valves. Am J Cardiol 2011 Feb 15;107(4):552-7. Epub 2010 Dec 22.

Studies:

Abstract

Warfarin is often used in patients with systolic heart failure (HF) to prevent adverse outcomes. However, its long-term effect remains controversial. The objective of this study was to determine the association of warfarin use and outcomes in patients with advanced chronic systolic HF without atrial fibrillation (AF), previous thromboembolic events, or prosthetic valves. Of the 2,708 BEST patients, 1,642 were free of AF without a history of thromboembolic events and without prosthetic valves at baseline. Of these, 471 patients (29%) were receiving warfarin. Propensity scores for warfarin use were estimated for each patient and were used to assemble a matched cohort of 354 pairs of patients with and without warfarin use who were balanced on 62 baseline characteristics. Kaplan-Meier and Cox regression analyses were used to estimate the association between warfarin use and outcomes during 4.5 years of follow-up. Matched participants had a mean age ± SD of 57 ± 13 years with 24% women and 24% African-Americans. All-cause mortality occurred in 30% of matched patients in the 2 groups receiving and not receiving warfarin (hazard ratio 0.86, 95% confidence interval 0.62 to 1.19, p = 0.361). Warfarin use was not associated with cardiovascular mortality (hazard ratio 0.97, 95% confidence interval 0.68 to 1.38, p = 0.855), or HF hospitalization (hazard ratio 1.09, 95% confidence interval 0.82 to 1.44, p = 0.568). In conclusion, in patients with chronic advanced systolic HF without AF or other recommended indications for anticoagulation, prevalence of warfarin use was high. However, despite a therapeutic international normalized ratio in those receiving warfarin, its use had no significant intrinsic association with mortality and hospitalization.