Italian Network - Congestive Heart Failure - IN-CHF

Description:

Utilization of oral anticoagulants in CHF and atrial fibrillation.

Hypothesis:

Evaluation of prevalence and appropriateness of oral anticoagulant therapy in congestive heart failure and atrial fibrillation.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 6,428
NYHA Class: 30% III-IV
Female: 26

Patient Populations:

Outpatient CHF population from 133 Italian centers

Primary Endpoints:

Use of anticoagulant and antiplatelet therapy

Principal Findings:

Among the 6428 patients with CHF, 1672 (26%) used oral anticoagulant therapy, and 35% used antiplatelet agents. A multivariate analysis showed that oral anticoagulant therapy was more often used for patients with concurrent atrial fibrillation (odds ratio 5.4; 95% CI, 4.6-6.3); ejection fractions < 30% compared to EF > 40% (odds ratio 2.2; 95% CI, 1.7-2.8); NYHA class III or IV heart failure, and CHF of ischemic etiology. Anticoagulant therapy was less common in the elderly or hypertensive cardiomyopathy.

Oral anticoagulant therapy was used in 726 of 1391 patients (52%) with atrial fibrillation, 449 of 1345 patients with EF < 30%, and 324 of 998 patients with LV diastolic diameters > 7cm.

Interpretation:

The use of oral anticoagulant therapy is recommended for patients with chronic atrial fibrillation, but of uncertain benefit for patients with ejection fractions < 30% or left ventricular diastolic diameters > 7cm. The use of oral anticoagulation therapy in only half of patients with atrial fibrillation suggests closer examination of guideline implementation is warranted. Conversely, eleven percent of patients without atrial fibrillation, EF <30%, or LVdD >7cm were taking oral anticoagulants; the benefits of anticoagulation in this population are uncertain. However, in this preliminary analysis, the investigators were unable to control for concomitant comorbidities or contraindications to warfarin therapy.

References:

1. Eur Heart J 1998;19(Abstr Suppl):298. Preliminary results

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Odds Ratio, Multivariate Analysis, Platelet Aggregation Inhibitors, Cardiomyopathies, Warfarin, Heart Failure, Comorbidity, Atrial Fibrillation


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