Antithrombotic therapies in patients with heart failure: hypothesis formulation from a research database

Heart failure is a significant public health problem. The present study is intended to explore in a research database whether antithrombotic therapies (ATTs) affect cardiovascular outcomes in patients with incident heart failure (IHF).

Using the United Kingdom Health Improvement Network research database, several multivariable models (including logistic and Cox's regression models, as well as propensity score methods) were used to examine all-cause mortality and clinical outcomes among five treatment groups.

The cohort included 24,554 patients with IHF (50.2% men), with a mean age (standard deviation [SD]) of 76.4 (11.0) years. Nearly three-fourths of patients received at least one form of ATT. Patients receiving ATTs tended to be younger and more likely to be men, and had more cardiovascular comorbidities. During the 18-month follow-up period, the mortality rates were 11.1%, 14.6%, 17.8%, 19.5%, and 32.6% for warfarin combination therapy, warfarin alone, clopidogrel therapy, aspirin (ASA) alone, and no therapy, respectively, yielding odds ratios (95%confidence intervals [CI]) relative to no therapy of 0.28 (0.24, 0.33), 0.38 (0.34, 0.43), 0.46 (0.40, 0.52), and 0.49 (0.45, 0.53) for each therapy group, accordingly. The use of ATTs also appeared to be associated with a reduced risk for ischemic or thrombotic events.

These data contribute to the formulation of the hypothesis that use of ATTs in clinical practice decreases the risk of morbidity and mortality in patients with IHF, although findings require further confirmative studies.