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Harlan M. Krumholz, MD; Ya-Ting Chen, PhD; Martha J. Radford, MD

Arch Intern Med. 2001;161:577-582.

Objectives  We sought (1) to determine how often aspirin is prescribed as a discharge medication among patients 65 years or older and hospitalized with both heart failure and coronary artery disease; (2) to identify patient characteristics associated with the decision to prescribe aspirin; and (3) to evaluate the association between aspirin prescription at discharge and 1-year survival.

Methods  We performed a retrospective cohort study of consecutive Medicare beneficiary survivors of a hospitalization for heart failure at 18 Connecticut hospitals (up to 200 hospitalizations per hospital) from 1994 to 1995.

Results  Among the 1110 patients in the study sample who did not have a contraindication to aspirin, aspirin therapy was prescribed for 456 (41%) at discharge. Patients who were prescribed aspirin at discharge had a lower 1-year mortality after discharge than patients who were not prescribed aspirin (odds ratio, 0.71; 95% confidence interval, 0.54-0.94), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the 2 groups.

Conclusions  This study has identified a strong association between the use of aspirin and lower mortality in older patients with both heart failure and coronary artery disease. The benefit of aspirin is consistent with that expected from randomized trials of other groups of patients with vascular disease.

From the Sections of Cardiovascular Medicine, Department of Medicine (Drs Krumholz and Radford) and Chronic Disease Epidemiology, Department of Epidemiology and Public Health (Dr Krumholz) and the Department of Medicine (Dr Chen), Yale University School of Medicine, New Haven, Conn; Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven (Drs Krumholz and Radford); and Qualidigm (formerly the Connecticut Peer Review Organization), Middletown, Conn (Drs Krumholz and Radford). Dr Chen's current affiliation is Merck and Co, Inc, West Point, Pa.

Reprints: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025 (e-mail: harlan.krumholz{at}yale.edu).

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