Association between aspirin use and mortality in critically ill patients with heart failure: a retrospective study...

Despite the established antithrombotic benefits of aspirin in cardiovascular disease, its efficacy remains controversial for critically ill patients with heart failure (HF) admitted to the intensive care unit (ICU).

To determine the association between aspirin use and all-cause survival outcomes in critically ill patients with HF.

This retrospective cohort study analyzed 9,562 patients with HF in the ICU from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were categorized into the aspirin and non-aspirin groups based on medications during ICU stay. Propensity score matching (PSM) was used to balance baseline characteristics. The primary outcome was 28-day mortality. The associations between aspirin use and mortality was assessed using Kaplan-Meier analysis and multivariable cox regression. Machine learning (ML) models with SHapley Additive exPlanation (SHAP) analysis were employed to evaluate the predictive value of aspirin. Further analyses were conducted to examine the relationship between aspirin dosage (81 mg and 325 mg) and patient survival.

Kaplan-Meier analysis demonstrated significantly higher survival rates in the aspirin group. Multivariable cox models confirmed aspirin use was independently associated with reduced mortality risk. ML models identified aspirin as an important predictor of survival. Subgroup analyses confirmed the consistency of this protective effect. No significant difference in mortality was observed between the 81 mg/day and 325 mg/day aspirin doses.

Aspirin is associated with significantly reduced mortality in patients with HF in the ICU.