Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Dec 31;6(4):953.
doi: 10.4022/jafib.953. eCollection 2013 Dec.

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

Zubin J Eapen  1   2 , Xiaojuan Mi  1 , Gregg C Fonarow  3 , Soko Setoguchi  1   2 , Jonathan P Piccini  1   2 , Roger M Mills  4 , Winslow Klaskala  5   6 , Lesley H Curtis  1   2 , Adrian F Hernandez  1   2
Affiliations

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

Zubin J Eapen et al. J Atr Fibrillation. .

Abstract

The risks and benefits of anticoagulation for patients with both heart failure and atrial fibrillation are unclear. We hypothesized that anticoagulation was associated with improved clinical outcomes of heart failure patients with atrial fibrillation independent of other risk factors. We conducted a retrospective cohort study of clinical registry data linked to Medicare claims for new users of oral anticoagulation (warfarin) without contraindications, discharged home alive, and stratified by CHADS2 score. Outcomes of interest were propensity score-adjusted estimates of the effects of warfarin at discharge on all-cause mortality, thromboembolic events, major adverse cardiovascular events, and bleeding events. Among 10,494 patients with heart failure and atrial fibrillation, the 2249 patients newly treated with warfarin had lower 1-year mortality (27.7% vs 39.3% for CHADS2 score ≤ 3 [P > .001]; 31.6% vs 41.8% for CHADS2 score > 3 [P > .001]) than patients not treated with warfarin. There was no significant difference in thromboembolic events, major adverse cardiovascular events, or bleeding events at 1 year. After multivariate adjustment, exposed individuals in both CHADS2 subgroups had lower adjusted 1-year mortality (CHADS2 ≤ 3: hazard ratio, 0.78 [95% confidence interval, 0.69-0.89]; CHADS2 >3: 0.78 [0.66-0.93]). In conclusion, warfarin use in heart failure patients with atrial fibrillation was associated with improved survival at 1 year independent of baseline CHADS2 score. However, there was no significant reduction in clinical events, such as thromboembolic or major adverse cardiovascular events at 1 year that might simply explain the survival benefit associated with warfarin.

Keywords: Atrial Fibrillation; Heart Failure; Hemorrhage; Mortality; Thromboembolism; Warfarin.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Cumulative Incidence of 1-Year Mortality Panel A: Patients with CHADS2 score ≤ 3 (hazard ratio, 0.78; 95% confidence interval, 0.69-0.89; P < .001). Panel B: Patients with CHADS2 score > 3 (hazard ratio, 0.78; 95% confidence interval, 0.66-0.93; P = .004).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Gage B F, Waterman A D, Shannon W, Boechler M, Rich M W, Radford M J. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001 Jun 13;285 (22):2864–70. - PubMed
    1. Swedberg Karl, Olsson Lars G, Charlesworth Andrew, Cleland John, Hanrath Peter, Komajda Michel, Metra Marco, Torp-Pedersen Christian, Poole-Wilson Philip. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur. Heart J. 2005 Jul;26 (13):1303–8. - PubMed
    1. You John J, Singer Daniel E, Howard Patricia A, Lane Deirdre A, Eckman Mark H, Fang Margaret C, Hylek Elaine M, Schulman Sam, Go Alan S, Hughes Michael, Spencer Frederick A, Manning Warren J, Halperin Jonathan L, Lip Gregory Y H. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 (2 Suppl):e531S–75S. - PMC - PubMed
    1. Arnold J Malcolm O, Liu Peter, Demers Catherine, Dorian Paul, Giannetti Nadia, Haddad Haissam, Heckman George A, Howlett Jonathan G, Ignaszewski Andrew, Johnstone David E, Jong Philip, McKelvie Robert S, Moe Gordon W, Parker John D, Rao Vivek, Ross Heather J, Sequeira Errol J, Svendsen Anna M, Teo Koon, Tsuyuki Ross T, White Michel. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol. 2006 Jan;22 (1):23–45. - PMC - PubMed
    1. Hunt Sharon Ann, Abraham William T, Chin Marshall H, Feldman Arthur M, Francis Gary S, Ganiats Theodore G, Jessup Mariell, Konstam Marvin A, Mancini Donna M, Michl Keith, Oates John A, Rahko Peter S, Silver Marc A, Stevenson Lynne Warner, Yancy Clyde W. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119 (14):e391–479. - PubMed