Heart Failure Severity and Quality of Warfarin Anticoagulation Control (From the WARCEF Trial)

AMERICAN JOURNAL OF CARDIOLOGY

卷:122

Article

Lee, Tetz C.¹  Qian, Min¹  Lip, Gregory Y. H.²  Di Tullio, Marco R.¹  Graham, Susan³  Mann, Douglas L.⁴  Nakanishi, Koki¹  Teerlink, John R.^5,6  Freudenberger, Ronald S.⁷  Sacco, Ralph L.⁸  Mohr, J. P.¹  Labovitz, Arthur J.⁹  Ponikowski, Piotr¹⁰  Lok, Dirk J.¹¹  Estol, Conrado¹²  Anker, Stefan D.^13,14,15,16  Pullicino, Patrick M.¹⁷  Buchsbaum, Richard¹  Levin, Bruce¹  Thompson, John L. P.¹  Homma, Shunichi¹  Ye, Siqin¹ 

[1] Columbia Univ, Irving Med Ctr, New York, NY 10027 USA

[2] Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England

[3] SUNY Buffalo, Buffalo, NY USA

[4] Washington Univ, Sch Med, St Louis, MO USA

[5] Univ Calif San Francisco, San Francisco Vet Affairs Med Ctr, Sect Cardiol, San Francisco, CA 94143 USA

[6] Univ Calif San Francisco, Sch Med, San Francisco, CA USA

[7] Lehigh Valley Hosp, Allentown, PA USA

[8] Univ Miami, Miami, FL USA

[9] Univ S Florida, Tampa, FL USA

[10] Mil Hosp, Wroclaw, Poland

[11] Deventer Hosp, Deventer, Netherlands

[12] Neurol Ctr Treatment & Rehabil, Buenos Aires, DF, Argentina

[13] Charite Univ Med Berlin, Dept Cardiol, Div Cardiol & Metab, Berlin, Germany

[14] Charite Univ Med Berlin, Berlin Brandenburg Ctr Regenerat Therapies, Berlin, Germany

[15] Charite Univ Med Berlin, Deutsch Zentrum Herz Kreislauf Forsch Partner Sit, Berlin, Germany

[16] Univ Med Gottingen, Dept Cardiol & Pneumol, Gottingen, Germany

[17] Kent Inst Med & Hlth Sci, Canterbury, Kent, England

DOI  :  10.1016/j.amjcard.2018.05.024

来源: Elsevier

【 摘 要 】

Previous studies in patients with atrial fibrillation showed that a history of heart failure (HF) could negatively impact anticoagulation quality, as measured by the average time in therapeutic range (TTR). Whether additional markers of HF severity are associated with TTR has not been investigated thoroughly. We aimed to examine the potential role of HF severity in the quality of warfarin control in patients with HF with reduced ejection fraction. Data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the association between TTR and HF severity. Multivariable logistic regression models were used to examine the association of markers of HF severity, including New York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and frequency of HF hospitalization, with TTR >= 70% (high TTR). We included 1,067 participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted analysis, patients with a high TTR were older and less likely to have had strokes or receive other antiplatelet agents. Those patients also had lower NYHA class, better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF hospitalizations. Multivariable analysis showed that NYHA class III and/or IV (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In HF patients with systolic dysfunction, NYHA class III and/or IV, poor health-related quality of life, and a higher rate of HF hospitalization were independently associated with suboptimal quality of warfarin anticoagulation control. These results affirm the need to assess the new approaches, such as direct oral anticoagulants, to prevent thromboembolism in this patient population. (C) 2018 Elsevier Inc. All rights reserved.

【 授权许可】

Free