NDLI: Quality of anticoagulation control in preventing adverse events in patients with heart failure in sinus rhythm: Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial substudy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Homma, Shunichi Thompson, John L. P. Qian, Min Ye, Siqin Di Tullio, Marco R. Lip, Gregory Y. H. Mann, Douglas L. Sacco, Ralph L. Levin, Bruce Pullicino, Patrick M. Freudenberger, Ronald S. Teerlink, John R. Graham, Susan Mohr, J. P. Labovitz, Arthur J. Buchsbaum, Richard Estol, Conrado J. Lok, Dirk J. Ponikowski, Piotr Anker, Stefan D.
Description	Author Affiliation: Homma S ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Thompson JL ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Qian M ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Ye S ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Di Tullio MR ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Lip GY ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Mann DL ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Sacco RL ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Levin B ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Pullicino PM ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Freudenberger RS ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Teerlink JR ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Graham S ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Mohr JP ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Labovitz AJ ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Buchsbaum R ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Estol CJ ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Lok DJ ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Ponikowski P ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY); Anker SD ( From the Division of Cardiology, Department of Medicine (S.H., S.Y., M.R., D.T.) and Department of Neurology (J.P.M.), Columbia University Medical Center, New York, NY)
Abstract	BACKGROUND: The aim of this study is to examine the relationship between time in the therapeutic range (TTR) and clinical outcomes in heart failure patients in sinus rhythm treated with warfarin. METHODS AND RESULTS: We used data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death), with death alone, ischemic stroke alone, major hemorrhage alone, and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin-treated patients, with TTR being treated as a time-dependent covariate. A total of 2217 patients were included in the analyses; among whom 1067 were randomized to warfarin and 1150 were randomized to aspirin. The median (interquartile range) follow-up duration was 3.6 (2.0-5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted P<0.001), death alone (adjusted P=0.001), and improved net clinical benefit (adjusted P<0.001). A similar trend was observed for the other 2 outcomes, but significance was not reached (adjusted P=0.082 for ischemic stroke and adjusted P=0.109 for major hemorrhage). CONCLUSIONS: In patients with heart failure in sinus rhythm, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041938.
File Format	HTM / HTML
ISSN	19413289
e-ISSN	19413297
DOI	10.1161/CIRCHEARTFAILURE.114.001725
Journal	Circulation: Heart Failure
Issue Number	3
Volume Number	8
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2015-05-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Cardiology Anticoagulants Therapeutic Use Aspirin Brain Ischemia Prevention & Control Cerebral Hemorrhage Heart Failure Drug Therapy Heart Rate Platelet Aggregation Inhibitors Stroke Volume Stroke Ventricular Function, Left Warfarin Adverse Effects Diagnosis Etiology Mortality Chi-square Distribution Double-blind Method Drug Monitoring Complications Physiopathology Multivariate Analysis Predictive Value Of Tests Proportional Hazards Models Risk Factors Time Factors Comparative Study Multicenter Study Randomized Controlled Trial Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine

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Quality of Anticoagulation Control in Preventing Adverse Events in Heart Failure Patients in Sinus Rhythm: A Warfarin Aspirin Reduced Cardiac Ejection Fraction Trial (WARCEF) Substudy

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