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Survival Benefit of Aspirin in Patients With Congestive Heart Failure: A Meta-Analysis
Sania Jiwani1, Usman Mustafa1, Sapna Desai2
1Louisiana State University Health Sciences Center - Center for Cardiovascular Diseases and Sciences, Shreveport, LA, USA.
Insights
Aspirin (ASA) use in congestive heart failure (CHF) patients significantly lowers all-cause mortality. While not impacting heart failure hospitalizations, ASA showed benefits when combined with nitrates or oral anticoagulants.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Consensus on aspirin (ASA) use in congestive heart failure (CHF) is lacking due to potential drug interactions.
- The study addresses the need for clarity on ASA's role in managing CHF patients.
Purpose of the Study:
- To evaluate the effect of aspirin on all-cause mortality in CHF patients.
- To assess the impact of aspirin on heart failure hospitalization rates.
- To identify factors influencing aspirin's efficacy in CHF.
Main Methods:
- Meta-analysis of 14 studies involving 64,550 patients with CHF.
- Systematic literature search using PubMed and reference lists.
- Random-effects model to combine effect sizes for mortality and hospitalization outcomes.
Main Results:
- Aspirin significantly reduced all-cause mortality in CHF patients (P = 0.003).
- No significant difference in heart failure hospitalization frequency was observed with aspirin use.
- Aspirin's mortality benefit was enhanced in patients also taking nitrates or oral anticoagulants.
- Concurrent use of oral anticoagulants and aspirin correlated with lower heart failure hospitalization rates (P = 0.02).
Conclusions:
- Aspirin demonstrates potential benefits for mortality in patients with heart failure.
- The findings suggest a nuanced role for aspirin in CHF management, particularly concerning concomitant medications.
Background:
There is no clear consensus on the use of aspirin (ASA) in patients with congestive heart failure (CHF) due to its reported interaction with other cardio-prudent medications. The aim was to evaluate the effect of ASA on all-cause mortality and the frequency of hospitalization for heart failure in patients with CHF using meta-analysis, as well as to study the potential variables interacting with this effect.
Methods:
Eligible studies were identified via a PubMed search, the "related article" feature and a manual search of references. Studies were included if they had a study population with CHF of any etiology, compared ASA to no ASA or placebo, and reported one or both of the following outcomes: 1) all-cause mortality and 2) the frequency of hospitalization for heart failure. Data were extracted and verified. We used the inverse variance method in a random-effects model to combine effect sizes.
Results:
A total of 14 studies with a combined study population of 64,550 patients were included in the final analysis. All-cause mortality was found to be significantly lower in patients who were taking ASA (P = 0.003). When examining the use of ASA, no significant difference was found in the frequency of hospitalization for heart failure. ASA use was demonstrated to be more beneficial against mortality in studies with a larger percentage of patients on nitrates (P = 0.008) and oral anticoagulants (P = 0.04). A significantly lower rate of hospitalization for heart failure was observed in patients who used oral anticoagulants and ASA concurrently (P = 0.02).
Conclusions:
ASA may have beneficial effects on mortality in patients with heart failure of all etiologies.
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