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

Autor: Lee TC; Columbia University Irving Medical Center, New York, New York. Electronic address: sl4190@columbia.edu., Qian M; Columbia University Irving Medical Center, New York, New York., Lip GYH; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom., Di Tullio MR; Columbia University Irving Medical Center, New York, New York., Graham S; The State University of New York at Buffalo, Buffalo, New York., Mann DL; Washington University School of Medicine, St. Louis, Missouri., Nakanishi K; Columbia University Irving Medical Center, New York, New York., Teerlink JR; Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California., Freudenberger RS; Lehigh Valley Hospital, Allentown, Pennsylvania., Sacco RL; The University of Miami, Miami, Florida., Mohr JP; Columbia University Irving Medical Center, New York, New York., Labovitz AJ; The University of South Florida, Tampa, Florida., Ponikowski P; Military Hospital, Wroclaw, Poland., Lok DJ; Deventer Hospital, Deventer, The Netherlands., Estol C; Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina., Anker SD; Division of Cardiology and Metabolism, Department of Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin; Charité Universitätsmedizin Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany., Pullicino PM; Kent Institute of Medicine and Health Science, Canterbury, United Kingdom., Buchsbaum R; Columbia University Irving Medical Center, New York, New York., Levin B; Columbia University Irving Medical Center, New York, New York., Thompson JLP; Columbia University Irving Medical Center, New York, New York., Homma S; Columbia University Irving Medical Center, New York, New York., Ye S; Columbia University Irving Medical Center, New York, New York.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2018 Sep 01; Vol. 122 (5), pp. 821-827. Date of Electronic Publication: 2018 Jun 04.
DOI: 10.1016/j.amjcard.2018.05.024
Abstrakt: 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.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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