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Aspirin and the treatment of heart failure in the elderly
H M Krumholz1, Y T Chen, M J Radford
1Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA. harlan.krumholz@yale.edu
Insights
Aspirin use at discharge was associated with lower 1-year mortality in older patients with heart failure and coronary artery disease. This finding supports aspirin
Area of Science:
- Cardiovascular Medicine
- Geriatric Medicine
- Pharmacology
Background:
- Heart failure and coronary artery disease frequently coexist in older adults.
- Aspirin is a cornerstone therapy for secondary prevention in vascular disease.
Purpose of the Study:
- To determine aspirin prescription rates at discharge for elderly patients with heart failure and coronary artery disease.
- To identify patient factors influencing aspirin prescription.
- To evaluate aspirin's impact on 1-year survival.
Main Methods:
- Retrospective cohort study of Medicare beneficiaries hospitalized for heart failure.
- Included patients aged 65+ with coexisting coronary artery disease.
- Analyzed discharge aspirin prescription and 1-year mortality.
Main Results:
- Aspirin was prescribed at discharge in 41% of eligible patients (456/1110).
- Aspirin prescription was linked to a 29% reduction in 1-year mortality (OR, 0.71; 95% CI, 0.54-0.94).
- This association persisted after adjusting for patient characteristics.
Conclusions:
- A strong association exists between aspirin use and reduced mortality in elderly patients with comorbid heart failure and coronary artery disease.
- Findings align with established benefits of aspirin in broader vascular disease populations.
Objectives:
We sought (1) to determine how often aspirin is prescribed as a discharge medication among patients 65 years or older and hospitalized with both heart failure and coronary artery disease; (2) to identify patient characteristics associated with the decision to prescribe aspirin; and (3) to evaluate the association between aspirin prescription at discharge and 1-year survival.
Methods:
We performed a retrospective cohort study of consecutive Medicare beneficiary survivors of a hospitalization for heart failure at 18 Connecticut hospitals (up to 200 hospitalizations per hospital) from 1994 to 1995.
Results:
Among the 1110 patients in the study sample who did not have a contraindication to aspirin, aspirin therapy was prescribed for 456 (41%) at discharge. Patients who were prescribed aspirin at discharge had a lower 1-year mortality after discharge than patients who were not prescribed aspirin (odds ratio, 0.71; 95% confidence interval, 0.54-0.94), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the 2 groups.
Conclusions:
This study has identified a strong association between the use of aspirin and lower mortality in older patients with both heart failure and coronary artery disease. The benefit of aspirin is consistent with that expected from randomized trials of other groups of patients with vascular disease.