Medicina clinica · 2025
Effect of oral anticoagulant treatment on mortality in patients with acute heart failure: Propensity score analysis. TAO-ICA study.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Fernandez-Rodriguez Maria de Los Angeles, Prieto-García Belén, López Díez María Pilar, Llorens Pere, Martín-Sánchez Francisco Javier, Gil Víctor, Jacob Javier, Llauger Lluís, Miró Òscar, Avanzas Pablo, Herrero-Puente Pablo, en representación del grupo ICA-SEMES
Аннотация
INTRODUCTION AND OBJECTIVE: There are no data on the effect of oral anticoagulant treatment on the prognosis of patients with acute heart failure (AHF). This study aimed to evaluate the effect of oral anticoagulant treatment on the short- and long-term prognosis of patients with an episode of AHF requiring hospital emergency department (ED) care.
METHOD: This was a prospective, multicentre, observational study with cohort follow-up. Basal and clinical data of the episode of patients diagnosed with AHF in the EDs of 41 Spanish hospitals were collected. Propensity score matching was performed and the crude and adjusted association of oral anticoagulant treatment with mortality was analysed at 30 days (primary objective) and at one year.
RESULTS: A total of 17635 patients were included, 42.9% of whom were previously receiving oral anticoagulants. Compared with non-anticoagulated patients, anticoagulated patients had a higher mean age (80,6 vs. 80,3, p=0,02), were predominantly female (56,5 vs. 54,9; p=0,035), had a high prevalence of risk factors and cardiovascular disease, and had a higher thrombotic risk. The 30-day [adjusted HR: 0,75 (95% CI: 0,63-0,89); p <0.001] and 1-year [adjusted HR: 0,81 (95% CI: 0,73-0,89); p <0,001] prognosis was better in patients in the anticoagulated group. After propensity score matching, the results did not differ at 30 days [HR: 0,73 (95% CI: 0,59-0,90); p <0,001] and at 1 year [HR: 0,82 (95% CI: 0,72-0,92); p <0,001].
CONCLUSIONS: Oral anticoagulation may be beneficial in patients with heart failure, regardless of the presence of AF. However, more randomized studies are needed to evaluate this hypothesis.
METHOD: This was a prospective, multicentre, observational study with cohort follow-up. Basal and clinical data of the episode of patients diagnosed with AHF in the EDs of 41 Spanish hospitals were collected. Propensity score matching was performed and the crude and adjusted association of oral anticoagulant treatment with mortality was analysed at 30 days (primary objective) and at one year.
RESULTS: A total of 17635 patients were included, 42.9% of whom were previously receiving oral anticoagulants. Compared with non-anticoagulated patients, anticoagulated patients had a higher mean age (80,6 vs. 80,3, p=0,02), were predominantly female (56,5 vs. 54,9; p=0,035), had a high prevalence of risk factors and cardiovascular disease, and had a higher thrombotic risk. The 30-day [adjusted HR: 0,75 (95% CI: 0,63-0,89); p <0.001] and 1-year [adjusted HR: 0,81 (95% CI: 0,73-0,89); p <0,001] prognosis was better in patients in the anticoagulated group. After propensity score matching, the results did not differ at 30 days [HR: 0,73 (95% CI: 0,59-0,90); p <0,001] and at 1 year [HR: 0,82 (95% CI: 0,72-0,92); p <0,001].
CONCLUSIONS: Oral anticoagulation may be beneficial in patients with heart failure, regardless of the presence of AF. However, more randomized studies are needed to evaluate this hypothesis.