Author + information
- Received August 18, 2017
- Revision received September 14, 2017
- Accepted September 19, 2017
- Published online January 30, 2018.
- Christian Madelaire, MDa,∗ (, )
- Gunnar Gislason, MD, PhDa,b,c,
- Søren L. Kristensen, MD, PhDd,
- Emil L. Fosbøl, MD, PhDe,
- Jenny Bjerre, MDa,
- Maria D’Souza, MDa,
- Finn Gustafsson, MD, PhD, DMSce,
- Lars Kober, MD, DMSce,
- Christian Torp-Pedersen, MD, DMScf,g and
- Morten Schou, MD, PhDa
- aDepartment of Cardiology, Cardiovascular Research Center, Gentofte and Herlev University Hospital, Hellerup, Denmark
- bNational Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- cCardiovascular Epidemiology and Outcomes Research, The Danish Heart Foundation, Copenhagen, Denmark
- dDepartment of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
- eDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark
- fDepartment of Health, Science, and Technology, Aalborg University, Aalborg, Denmark
- gDepartment of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Christian Madelaire, Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Cardiovascular Research Unit 1–Post 635, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
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.
Dr. Torp-Pedersen has received grants and speaker honoraria from Bayer. Dr. D’Souza has received grants from the Danish Heart Foundation and the VELUX Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2017.
- Revision received September 14, 2017.
- Accepted September 19, 2017.
- 2018 American College of Cardiology Foundation
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