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Abstract 295: Potential Effectiveness for Anticoagulation Among Elderly Heart Failure Patients without Atrial Fibrillation? An Analysis of the ADHERE Registry Linked to Medicare Claims


 Background:
 Prior studies suggest heart failure (HF) patients are at higher risk for thromboembolic events even in the absence of atrial fibrillation (AF), but the effect of anticoagulation on HF outcomes is uncertain.
 
 
 Methods:
 Using data from 2001 to 2006 from the ADHERE registry linked to Medicare claims we estimated 1-year cumulative incidence rates of a) mortality, b) thromboembolic events, and c) major adverse cardiovascular events (MACE) and d) readmission for HF. Eligibility criteria included: ejection fraction ≤ 35%, no concomitant AF, alive at discharge, and naïve to anticoagulation at admission. The adjusted associations between anticoagulation and 1-year outcomes were estimated using the inverse probability of treatment weighting method.
 
 
 Results:
 Of 13,217 patients in 276 hospitals, 1,140 (8.6%) received anticoagulation at discharge. Compared to patients without anticoagulation, patients with anticoagulation were slightly younger (77.0 vs. 78.2 years, P<0.001), more often male (60.5% vs. 53.6%, P<0.001), had lesser disease severity and comorbidity (e.g. coronary artery disease, diabetes mellitus, and hypertension) and were less likely to be discharged on anti-platelet therapy (aspirin: 46.2% vs. 64.4%, clopidogrel: 9.9% vs. 19.9%; P < 0.001 for each). The occurrence of all-cause mortality, thromboembolic events, MACE, and HF rehospitalization between non-anticoagulated and anticoagulated groups was 32.3% vs. 27.2% (P<.001); 3.9% vs. 4.7%, (p=0.212); 7.6% vs. 6.2%, (p =0.093); and 35.4% vs. 29.4% (P<.001), respectively. Figure shows the cumultative incidence of rehospitalization after discharge by anticoagulation status. After adjustment, the decrease in rehospitalization for HF associated with anticoagulation was the only outcome that retained statistical significance
 
 
 Conclusion:
 Anticoagulation with warfarin at discharge among older HF patients with systolic dysfunction without atrial fibrillation not previously treated is infrequent. There were no statistically significant propensity weighted associations between anticoagulation and 1-year outcomes except for moderately lower risk for HF rehospitalization
 
 
 
