Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients: From the WARCEF Trial

WARCEF Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Background Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. Methods We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). Results After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Conclusions Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)

Original languageEnglish (US)
Pages (from-to)603-610
Number of pages8
JournalJACC: Heart Failure
Volume5
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Aspirin
Heart Failure
Warfarin
Hospitalization
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Confidence Intervals
Prostaglandin-Endoperoxide Synthases

Keywords

  • aspirin
  • heart failure
  • hospitalization
  • survival
  • warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients : From the WARCEF Trial. / WARCEF Investigators.

In: JACC: Heart Failure, Vol. 5, No. 8, 01.08.2017, p. 603-610.

Research output: Contribution to journalArticle

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title = "Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients: From the WARCEF Trial",
abstract = "Objectives The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Background Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. Methods We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6{\%} on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). Results After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95{\%} confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95{\%} confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Conclusions Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)",
keywords = "aspirin, heart failure, hospitalization, survival, warfarin",
author = "{WARCEF Investigators} and Teerlink, {John R.} and Min Qian and Bello, {Natalie A.} and Freudenberger, {Ronald S.} and Bruce Levin and {Di Tullio}, {Marco R.} and Susan Graham and Mann, {Douglas L.} and Sacco, {Ralph L} and Mohr, {J. P.} and Lip, {Gregory Y.H.} and Labovitz, {Arthur J.} and Lee, {Seitetz C.} and Piotr Ponikowski and Lok, {Dirk J.} and Anker, {Stefan D.} and Thompson, {John L.P.} and Shunichi Homma",
year = "2017",
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T1 - Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients

T2 - From the WARCEF Trial

AU - WARCEF Investigators

AU - Teerlink, John R.

AU - Qian, Min

AU - Bello, Natalie A.

AU - Freudenberger, Ronald S.

AU - Levin, Bruce

AU - Di Tullio, Marco R.

AU - Graham, Susan

AU - Mann, Douglas L.

AU - Sacco, Ralph L

AU - Mohr, J. P.

AU - Lip, Gregory Y.H.

AU - Labovitz, Arthur J.

AU - Lee, Seitetz C.

AU - Ponikowski, Piotr

AU - Lok, Dirk J.

AU - Anker, Stefan D.

AU - Thompson, John L.P.

AU - Homma, Shunichi

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N2 - Objectives The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Background Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. Methods We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). Results After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Conclusions Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)

AB - Objectives The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Background Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. Methods We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). Results After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. Conclusions Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938)

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KW - hospitalization

KW - survival

KW - warfarin

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