Does aspirin use adversely influence intermediate-term postdischarge outcomes for hospitalized patients who are treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers? Findings from Organized Program to Facilitate Life-Saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Received 29 September 2009; accepted 11 November 2009.
Background
Conflicting data exist regarding a potential deleterious association between aspirin (ASA) and angiotensin-converting enzyme inhibitors (ACEIs) when used concurrently in patients with heart failure (HF). How such an interaction may be influenced by underlying etiology of HF and whether it extends to patients treated with angiotensin receptor blockers (ARBs), however, are not known.
Methods
Eligible patients from the OPTIMIZE-HF registry were dichotomized into those with ischemic or nonischemic HF. Potential associations between ASA and ACEI or ARB use and 60- to 90-day postdischarge outcomes were assessed using Cox proportional and logistic regression modeling. Models were adjusted for factors known to influence the outcome of interest and by propensity score for ACEI or ARB prescription after an index HF admission.
Results
Mortality was not increased (hazard ratio [95% CI]) when ASA was used in conjunction with ACEI (0.51 [0.29-0.87]) or ARB (0.29 [0.09-0.96]) in patients with ischemic or nonischemic (ACEI 0.71 [0.42-1.21], ARB 1.42 [0.74-2.74]) HF. Regression model parameter estimates trended toward harm reduction, but interaction terms for mortality and a composite of mortality or rehospitalization were nonsignificant (P for all >.05).
Conclusions
When combined with ACEI or ARB, ASA had no demonstrable adverse effect on intermediate-term postdischarge outcomes for patients with ischemic or nonischemic HF.
aDepartment of Emergency Medicine and the Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI
bDepartment of Internal Medicine, Wayne State University School of Medicine, Detroit, MI
dDepartment of Cardiology, Detroit Medical Center, Detroit, MI
eDepartment of Medicine, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA
fDivision of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
gDepartment of Medicine, Duke University School of Medicine, Durham, NC
Reprint requests: Phillip D. Levy, MD, MPH, Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201.
ABSTRACT