Document Detail


Aspirin use and outcomes in a community-based cohort of 7352 patients discharged after first hospitalization for heart failure.
MedLine Citation:
PMID:  16735672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The safety of aspirin in heart failure (HF) has been called into question, particularly in those patients (1) without coronary disease, (2) with renal dysfunction, or (3) treated with low-dose angiotensin-converting enzyme (ACE) inhibitors and high-dose aspirin. METHODS AND RESULTS: We examined prescription patterns and outcomes (all-cause mortality and/or HF readmission) in patients discharged from 103 Canadian hospitals between April 1999 and March 2001 after a first hospitalization for HF. Of 7352 patients with HF (mean age, 75 years; 44% without coronary disease and 29% with renal dysfunction), 2785 (38%) died or required HF readmission within the first year. Compared with nonusers, aspirin users were no more likely to die or require HF readmission (hazard ratio [HR], 1.02 [0.91 to 1.16]), even in patients without coronary disease (HR, 0.98 [0.78 to 1.22]) or patients with renal dysfunction (HR, 1.13 [0.94 to 1.36]). On the other hand, users of ACE inhibitors were less likely to die or require HF readmission (HR, 0.87 [0.79 to 0.96]), even if they were using aspirin (HR, 0.86 [0.77 to 0.95]). There were no dose-dependent interactions between aspirin and ACE inhibitors. CONCLUSIONS: In this observational study, aspirin use was not associated with an increase in mortality rates or HF readmission rates, and aspirin did not attenuate the benefits of ACE inhibitors, even in patients without coronary disease, patients with renal dysfunction, or patients treated with high-dose aspirin and low-dose ACE inhibitors.
Authors:
Finlay A McAlister; William A Ghali; Yanyan Gong; Jiming Fang; Paul W Armstrong; Jack V Tu
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-05-30
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-06     Completed Date:  2006-06-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2572-8     Citation Subset:  AIM; IM    
Affiliation:
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / pharmacology*,  therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*,  pharmacology
Aspirin / adverse effects*,  pharmacology
Cohort Studies
Coronary Disease / complications,  physiopathology
Dose-Response Relationship, Drug
Drug Interactions
Drug Therapy, Combination
Drug Toxicity
Female
Heart Failure / complications,  drug therapy*,  mortality
Hemodynamics / drug effects,  physiology
Humans
Kidney Diseases / complications,  physiopathology
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Readmission / statistics & numerical data
Prognosis
Proportional Hazards Models
Prospective Studies
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Inflammatory Agents, Non-Steroidal; 50-78-2/Aspirin
Comments/Corrections
Comment In:
Circulation. 2006 Jun 6;113(22):2566-8   [PMID:  16754810 ]
Circulation. 2007 Jan 30;115(4):e54; author reply e55   [PMID:  17261667 ]

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