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Aspirin and the Treatment of Heart Failure in the Elderly
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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