Author + information
- Received April 13, 2004
- Revision received July 20, 2004
- Accepted July 28, 2004
- Published online September 20, 2005.
- Frederick A. Masoudi, MD, MSPH, FACC⁎,†,‡,§,⁎ (, )
- Pam Wolfe, MA, MS§,
- Edward P. Havranek, MD, FACC⁎,†,§,
- Saif S. Rathore, MPH∥,
- JoAnne M. Foody, MD∥ and
- Harlan M. Krumholz, MD, FACC§∥,¶,#
- ↵⁎Reprint requests and correspondence:
Dr. Frederick A. Masoudi, Division of Cardiology MC 0960, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204.
Objectives We sought to determine patterns of aspirin use and the relationship between aspirin prescription and outcomes in patients with coronary artery disease (CAD) and heart failure (HF).
Background Because of the potential for exacerbating hypertension or renal insufficiency and possible interactions with angiotensin-converting enzyme (ACE) inhibitors, the use of aspirin for secondary prevention of coronary events is controversial in patients with HF.
Methods We studied a national sample of Medicare beneficiaries ≥65 years old after hospitalization for HF with CAD and without aspirin contraindications between April 1998 and June 2001. We assessed factors associated with aspirin prescription and the relationship between aspirin and outcomes in regression models accounting for differences in patient, physician, and hospital characteristics and for clustering of patients by hospital.
Results Of the 24,012 patients, 54% received aspirin. Treated patients had lower unadjusted rates of death (31% vs. 39% for those not receiving aspirin, p < 0.001). In multivariable analyses, aspirin remained associated with a lower risk of death (risk ratio [RR] 0.94; 95% confidence interval [CI] 0.90 to 0.99). This association was similar regardless of hypertension, renal insufficiency, or treatment with ACE inhibitors (p for all interactions > 0.2). Aspirin also was associated with lower risks of death or all-cause readmission (RR 0.98; 95% CI 0.97 to 0.99) and of death or readmission for HF (RR 0.98; 95% CI 0.96 to 0.99).
Conclusions Almost one-half of patients with CAD hospitalized for HF in the U.S. are not treated with aspirin. This study found no evidence of harm from aspirin in this population and suggests a treatment benefit. Withholding aspirin based upon theoretical concerns about adverse effects appears to be unjustified.
Dr. Masoudi is supported by NIH/NIA Research Career Award K08-AG01011, and has received honoraria from Pfizer and AstraZeneca. Mr. Rathore was supported by NIH Medical Scientist Training Grant GM07205. Dr. Foody is supported by NIH/NIA Research Career Award K08-AG20623 and NIA/Hartford Foundation Fellowship in Geriatrics, and has received honoraria from Pfizer, Merck, and Bristol-Myers Squibb. Dr. Havranek as received honoraria from and has been a consultant for Bristol-Myers Squibb. The analyses upon which this publication is based were performed under Contract Number 500-99-C001 entitled “Utilization and Quality Control Peer Review Organization for the State of Colorado,” sponsored by the Center for Medicare and Medicaid Services, Department of Health and Human Services. The content of the publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Center for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experiences in engaging with issues presented are welcomed.
- Received April 13, 2004.
- Revision received July 20, 2004.
- Accepted July 28, 2004.
- American College of Cardiology Foundation