Published Online
on May 30, 2006

A more recent version of this article appeared on June 6, 2006

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Submitted on November 16, 2005
Revised on March 23, 2006
Accepted on March 24, 2006

Aspirin Use and Outcomes in a Community-Based Cohort of 7352 Patients Discharged After First Hospitalization for Heart Failure

Finlay A. McAlister MD, MSc^*, William A. Ghali MD, MPH, Yanyan Gong MSc, Jiming Fang PhD, Paul W. Armstrong MD, and Jack V. Tu MD, PhD

From the Division of General Internal Medicine (F.A.M.) and the Division of Cardiology (P.W.A.), University of Alberta, Edmonton, Canada; the Division of General Internal Medicine, University of Calgary, Calgary, Canada (W.A.G.); the Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada (Y.G., J.F.); and the Division of General Internal Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Toronto, Canada (J.V.T.).

^* To whom correspondence should be addressed. E-mail: Finlay.McAlister{at}ualberta.ca.

Background--The safety of aspirin in heart failure (HF) has been called into question, particularly in those patients (1) without coronary disease, (2) with renal dysfunction, or (3) treated with low-dose angiotensin-converting enzyme (ACE) inhibitors and high-dose aspirin.

Methods and Results--We examined prescription patterns and outcomes (all-cause mortality and/or HF readmission) in patients discharged from 103 Canadian hospitals between April 1999 and March 2001 after a first hospitalization for HF. Of 7352 patients with HF (mean age, 75 years; 44% without coronary disease and 29% with renal dysfunction), 2785 (38%) died or required HF readmission within the first year. Compared with nonusers, aspirin users were no more likely to die or require HF readmission (hazard ratio [HR], 1.02 [0.91 to 1.16]), even in patients without coronary disease (HR, 0.98 [0.78 to 1.22]) or patients with renal dysfunction (HR, 1.13 [0.94 to 1.36]). On the other hand, users of ACE inhibitors were less likely to die or require HF readmission (HR, 0.87 [0.79 to 0.96]), even if they were using aspirin (HR, 0.86 [0.77 to 0.95]). There were no dose-dependent interactions between aspirin and ACE inhibitors.

Conclusions--In this observational study, aspirin use was not associated with an increase in mortality rates or HF readmission rates, and aspirin did not attenuate the benefits of ACE inhibitors, even in patients without coronary disease, patients with renal dysfunction, or patients treated with high-dose aspirin and low-dose ACE inhibitors.

Key words: aspirin • heart failure • outcomes

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