Low-Dose Aspirin Ups Survival in Heart Failure: Community-Based Cohort Study

February 07, 2014

DUBLIN, IRELAND — Daily low-dose aspirin, defined as 75 mg/day, was followed by a 42% mortality reduction over several years in a cohort of patients participating in a heart-failure disease-management program[1]. Aspirin prolonged survival regardless of whether patients had a standard aspirin indication, such as ischemic heart disease, peripheral vascular disease, or stroke, reported investigators in their study, published online February 3, 2014 in Circulation: Heart Failure. There was no such survival benefit, however, at dosages higher than 75 mg/day, although both low- and higher-dose aspirin improved heart-failure hospitalizations.

The findings contrast with and go beyond prior studies of narrower heart-failure populations treated with aspirin, observe its authors, led by Dr Margaret Bermingham (St Vincent's University Hospital, Dublin, Ireland). Of those randomized trials, they note, WARCEF saw more bleeding and otherwise no clinical advantage for warfarin over aspirin; and in WASH and WATCH , neither aspirin nor warfarin seemed to protect against events.

But the group notes that aspirin in those trials was given at two to four times the low dose of the current analysis, which suggests "that low-dose aspirin may have a continuing role in secondary prevention once patients are diagnosed with HF" and points to a need for "more, preferably prospective, trials of low-dose aspirin use in HF."

Of the 1476 patients in the retrospective analysis, who were followed for a median of 2.15 years (range one day to 12 years), 892 (about 60%) were prescribed aspirin at baseline. Of those, 91% received aspirin at 75 mg/day and the remainder received aspirin at higher dosages.

Another antiplatelet, such as clopidogrel, was also given to 18.4% of the aspirin group, while 27.8% of them took added warfarin, and 2.1% received dual antiplatelets and warfarin.

End-Point Hazard Ratios (95% CI) for Low-Dose vs High-Dose Aspirin vs None

End point Low-dose aspirin vs no aspirin Low-dose aspirin vs high-dose aspirin High-dose aspirin v no aspirin
Mortality 0.58 (0.46–0.74) 0.57 (0.35–0.92) 0.98 (0.59–1.63)
HF hospitalization 0.70 (0.54–0.90) 1.27 (0.70–2.30) 0.50 (0.27–0.92)

Adjusted for age, sex, natriuretic-peptide levels, creatinine levels, heart-failure etiology, ischemic heart disease, atrial fibrillation, hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease, peripheral vascular disease, and stroke

The findings "add to the controversy on aspirin use in HF by presenting reassuring results on low-dose aspirin use in a clinical-practice population," the group writes. "They challenge the belief that aspirin should be avoided in secondary-prevention patients who go on to develop HF and suggest that patients on higher antiplatelet doses may benefit from dose reduction."

Bermingham had no conflicts of interest. Disclosures for the coauthors are listed in the paper.


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