Does aspirin use adversely influence intermediate-term postdischarge outcomes for hospitalized patients who are treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers? Findings from Organized Program to Facilitate Life-Saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)

Department of Emergency Medicine and the Cardiovascular Research Institute, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA.
American heart journal (Impact Factor: 4.46). 02/2010; 159(2):222-230.e2. DOI: 10.1016/j.ahj.2009.11.009
Source: PubMed


Conflicting data exist regarding a potential deleterious association between aspirin (ASA) and angiotensin-converting enzyme inhibitors (ACEIs) when used concurrently in patients with heart failure (HF). How such an interaction may be influenced by underlying etiology of HF and whether it extends to patients treated with angiotensin receptor blockers (ARBs), however, are not known.
Eligible patients from the OPTIMIZE-HF registry were dichotomized into those with ischemic or nonischemic HF. Potential associations between ASA and ACEI or ARB use and 60- to 90-day postdischarge outcomes were assessed using Cox proportional and logistic regression modeling. Models were adjusted for factors known to influence the outcome of interest and by propensity score for ACEI or ARB prescription after an index HF admission.
Mortality was not increased (hazard ratio [95% CI]) when ASA was used in conjunction with ACEI (0.51 [0.29-0.87]) or ARB (0.29 [0.09-0.96]) in patients with ischemic or nonischemic (ACEI 0.71 [0.42-1.21], ARB 1.42 [0.74-2.74]) HF. Regression model parameter estimates trended toward harm reduction, but interaction terms for mortality and a composite of mortality or rehospitalization were nonsignificant (P for all >.05).
When combined with ACEI or ARB, ASA had no demonstrable adverse effect on intermediate-term postdischarge outcomes for patients with ischemic or nonischemic HF.

63 Reads
  • Source

    Preview · Article · May 2011 · Circulation Heart Failure
  • [Show abstract] [Hide abstract]
    ABSTRACT: Blood platelets play a key role in atherothrombosis due to their ability of thrombus formation after rupture of an atherosclerotic plaque. Numerous clinical trials have established the efficacy of platelet function blockade in the prevention of acute coronary syndromes. Meanwhile, nearly all patients undergoing cardiopulmonary bypass grafting present with antiplatelet therapy. Platelets interact also with endothelial cells, leukocytes, and smooth muscle cells and are involved in vascular inflammation. This may result in an excessive fibroproliferative response after vessel dilatation. Furthermore, many PLT blockers are associated with response variability up to non-responsiveness leading to increased re-intervention and transfusion rates both identified as independent risk factors for an adverse clinical outcome after coronary interventions. Summarizing the role of platelets for normal hemostasis and the pathophysiology of atherothrombosis, this review describes the current status of antiplatelet therapy and highlights some new antiplatelet drugs in the prevention of serious cardiovascular events.
    No preview · Article · Oct 2012 · Journal of cardiovascular pharmacology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Existing data sources for heart failure research offer advantages and disadvantages for comparative effectiveness research. Clinical registries collect detailed information about disease presentation, treatment, and outcomes on a large number of patients and provide the "real-world" population that is the hallmark of comparative effectiveness research. Data are not collected longitudinally, however, and follow-up is often limited. Large administrative datasets provide the broadest population coverage with longitudinal outcomes follow-up but lack clinical detail. Linking clinical registries with other databases to assess longitudinal outcomes holds great promise.
    No preview · Article · Jan 2013 · Heart Failure Clinics
Show more