TY - JOUR
T1 - Benefit of warfarin compared with aspirin in patients with heart failure in sinus rhythm
T2 - A subgroup analysis of WARCEF, a randomized controlled trial
AU - Homma, Shunichi
AU - Thompson, John L.P.
AU - Sanford, Alexandra R.
AU - Mann, Douglas L.
AU - Sacco, Ralph L.
AU - Levin, Bruce
AU - Pullicino, Patrick M.
AU - Freudenberger, Ronald S.
AU - Teerlink, John R.
AU - Graham, Susan
AU - Mohr, J. P.
AU - Massie, Barry M.
AU - Labovitz, Arthur J.
AU - Di Tullio, Marco R.
AU - Gabriel, André P.
AU - Lip, Gregory Y.H.
AU - Estol, Conrado J.
AU - Lok, Dirk J.
AU - Ponikowski, Piotr
AU - Anker, Stefan D.
PY - 2013/9
Y1 - 2013/9
N2 - Background-The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome between warfarin and aspirin in 2305 patients with reduced left ventricular ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin. Methods and Results-We used a Cox model stepwise selection procedure to identify subgroups that may benefit from warfarin or aspirin on the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age group was a significant treatment effect modifier (P for interaction, 0.003). Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09; 95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added, in younger patients the event rate remained lower for warfarin than aspirin (5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P=0.005), but in older patients it became significantly higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio, 1.25; 95% confidence interval, 1.02-1.53; P=0.03). Conclusions-In patients <60 years, warfarin improved outcomes over aspirin with or without inclusion of major hemorrhage. In patients ≥60 years, there was no treatment difference, but the aspirin group had significantly better outcomes when major hemorrhage was included.
AB - Background-The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome between warfarin and aspirin in 2305 patients with reduced left ventricular ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin. Methods and Results-We used a Cox model stepwise selection procedure to identify subgroups that may benefit from warfarin or aspirin on the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age group was a significant treatment effect modifier (P for interaction, 0.003). Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09; 95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added, in younger patients the event rate remained lower for warfarin than aspirin (5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P=0.005), but in older patients it became significantly higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio, 1.25; 95% confidence interval, 1.02-1.53; P=0.03). Conclusions-In patients <60 years, warfarin improved outcomes over aspirin with or without inclusion of major hemorrhage. In patients ≥60 years, there was no treatment difference, but the aspirin group had significantly better outcomes when major hemorrhage was included.
KW - Aspirin
KW - Heart failure
KW - Sinus rhythm
KW - Stroke
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=84887484369&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.113.000372
DO - 10.1161/CIRCHEARTFAILURE.113.000372
M3 - Article
C2 - 23881846
AN - SCOPUS:84887484369
SN - 1941-3289
VL - 6
SP - 988
EP - 997
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 5
ER -