Aspirin Use In Heart Failure: Is Low Dose Therapy Associated With Mortality And Morbidity Benefits In A Large Community Population?
Background—Aspirin use in heart failure (HF) is controversial. The drug has proven benefit in co-morbidities associated with HF however retrospective analysis of ACE inhibitor trials and prospective comparisons with warfarin have shown increased risk of morbidity with aspirin use. This study aims to evaluate the association of low-dose aspirin with mortality and morbidity risk in a large community-based cohort.
Methods and Results—This was a retrospective cohort study of patients attending a HF disease management program. Aspirin use at baseline and its association with mortality and HF hospitalization in the population was examined. Of 1476 patients (mean age 70.4±12.4 years, 63% male), 892 (60.4%) were prescribed aspirin. Low-dose aspirin (75mg/day) was prescribed to 828 (92.8%) patients. Median follow-up time was 2.6 [0.8:4.5] years. Over the follow-up period, 464 (31.4%) patients died. In adjusted analysis, low-dose aspirin use was associated with reduced mortality risk compared to non-aspirin use (HR=0.58, 95% CI 0.46-0.74) and this was confirmed by a propensity matched subgroup analysis. Low-dose aspirin use was associated with reduced risk of HF hospitalization compared to non-aspirin use in the total population (adjusted HR=0.70, 95% CI 0.54-0.90). In adjusted analysis, there was no difference in mortality or HF hospitalization between high-dose aspirin users (>75mg/day) and non-aspirin users.
Conclusions—In this study low-dose aspirin therapy was associated with a significant reduction in mortality and morbidity risk over long-term follow-up. These results suggest that low-dose aspirin may have a continuing role in secondary prevention in HF and underline the need for more trials of low-dose aspirin use in HF.
- Received January 24, 2013.
- Accepted January 28, 2014.