Title |
Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients From the WARCEF Trial
|
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Published in |
JACC: Heart Failure, August 2017
|
DOI | 10.1016/j.jchf.2017.04.011 |
Pubmed ID | |
Authors |
John R. Teerlink, Min Qian, Natalie A. Bello, Ronald S. Freudenberger, Bruce Levin, Marco R. Di Tullio, Susan Graham, Douglas L. Mann, Ralph L. Sacco, J.P. Mohr, Gregory Y.H. Lip, Arthur J. Labovitz, Seitetz C. Lee, Piotr Ponikowski, Dirk J. Lok, Stefan D. Anker, John L.P. Thompson, Shunichi Homma, WARCEF Investigators |
Abstract |
The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938). |
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Country | Count | As % |
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Spain | 7 | 23% |
United States | 4 | 13% |
France | 1 | 3% |
Saudi Arabia | 1 | 3% |
Venezuela, Bolivarian Republic of | 1 | 3% |
Belgium | 1 | 3% |
Unknown | 15 | 50% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 20 | 67% |
Practitioners (doctors, other healthcare professionals) | 5 | 17% |
Scientists | 4 | 13% |
Science communicators (journalists, bloggers, editors) | 1 | 3% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 62 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 9 | 15% |
Student > Bachelor | 7 | 11% |
Student > Master | 6 | 10% |
Professor | 4 | 6% |
Student > Postgraduate | 4 | 6% |
Other | 10 | 16% |
Unknown | 22 | 35% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 15 | 24% |
Pharmacology, Toxicology and Pharmaceutical Science | 7 | 11% |
Nursing and Health Professions | 7 | 11% |
Biochemistry, Genetics and Molecular Biology | 2 | 3% |
Psychology | 2 | 3% |
Other | 3 | 5% |
Unknown | 26 | 42% |