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Anticoagulation and Clinical Outcomes in Heart Failure Patients With Atrial Fibrillation: Findings From the ADHERE

Zubin J Eapen1,2, Xiaojuan Mi1, Gregg C Fonarow3

  • 1Duke Clinical Research Institute.

Journal of Atrial Fibrillation
|May 13, 2017
PubMed

Insights

Anticoagulation with warfarin in patients with heart failure and atrial fibrillation improved 1-year survival. This benefit was observed regardless of patient risk factors, though it did not significantly reduce other clinical events.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The risks and benefits of anticoagulation in patients with coexisting heart failure and atrial fibrillation are not well-defined.
  • Oral anticoagulation is a cornerstone therapy for stroke prevention in atrial fibrillation.

Purpose of the Study:

  • To investigate the association between oral anticoagulation (warfarin) and clinical outcomes in patients with heart failure and atrial fibrillation.
  • To determine if warfarin use impacts all-cause mortality, thromboembolic events, major adverse cardiovascular events, and bleeding events.

Main Methods:

  • Retrospective cohort study using clinical registry data linked to Medicare claims.
  • Included new users of warfarin without contraindications, stratified by CHADS 2 score.
  • Propensity score-adjusted analyses were performed to estimate treatment effects.

Main Results:

  • Newly treated warfarin patients (n=2249) showed significantly lower 1-year mortality compared to non-warfarin users (n=8245) across all CHADS 2 score strata.
  • Adjusted analyses confirmed warfarin use was associated with a 22% reduction in 1-year mortality (HR 0.78, 95% CI 0.69-0.89).
  • No significant differences were found in 1-year thromboembolic events, major adverse cardiovascular events, or bleeding events between groups.

Conclusions:

  • Warfarin use in heart failure patients with atrial fibrillation is associated with improved 1-year survival, independent of baseline CHADS 2 score.
  • The survival benefit appears unrelated to a reduction in thromboembolic or major adverse cardiovascular events.
  • Further research is needed to elucidate the mechanisms behind the observed survival advantage.

Keywords:
Atrial FibrillationHeart FailureHemorrhageMortalityThromboembolismWarfarin

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