Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study)
| Autor: | M, Echemann, F, Alla, S, Briançon, Y, Juillière, J M, Virion, P M, Mertès, J P, Villemot, F, Zannad, E, Aliot, Ch, Breton, K, KhalifE, J L, Neimann, S, Allam, Ph, Admant, N, Baille, Ph, Bellanger, R, D'Hôtel, P, Dambrine, J F, Dodet, M, Graille, M, Kessler, G, Rebeix, Royer, J P, Saulnier, J Y, Thisse, B, Trutt, Ph, Vidal, M Ch, Vuillemin, Delahaye, P, Ducimetière, F, Fagnani, L, Guize |
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| Rok vydání: | 2002 |
| Předmět: |
Adult
Male medicine.medical_specialty Databases Factual Systole Population Adrenergic beta-Antagonists Angiotensin-Converting Enzyme Inhibitors Severity of Illness Index Ventricular Dysfunction Left Fibrinolytic Agents Internal medicine Severity of illness Antithrombotic medicine Humans Decompensation Prospective Studies education Survival analysis Aged Hypolipidemic Agents Aged 80 and over Heart Failure Aspirin education.field_of_study Dose-Response Relationship Drug Proportional hazards model business.industry Anticoagulants Middle Aged medicine.disease Survival Analysis Treatment Outcome Heart failure Cardiology Female Controlled Clinical Trials as Topic France Cardiology and Cardiovascular Medicine business medicine.drug Follow-Up Studies |
| Zdroj: | European journal of heart failure. 4(5) |
| ISSN: | 1388-9842 |
| Popis: | Background: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. Methods: The EPICAL study (Epidemiologie de l'Insuffisance Cardiaque Avancee en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20–80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction ≤30% or cardiothoracic index ≥60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. Results: Duration of disease >1 year, renal failure, serum sodium ≥138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. Conclusion: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure. |
| Databáze: | OpenAIRE |
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