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Outcomes associated with warfarin use in older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device: findings from the ADHERE registry linked to Medicare claims.

Publication ,  Journal Article
Hess, PL; Greiner, MA; Fonarow, GC; Klaskala, W; Mills, RM; Setoguchi, S; Al-Khatib, SM; Hernandez, AF; Curtis, LH
Published in: Clin Cardiol
November 2012

BACKGROUND: Warfarin use and associated outcomes in patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device have not been described previously. HYPOTHESIS: We hypothesized that warfarin is underused and is associated with lower risks of mortality, thromboembolic events, and myocardial infarction. METHODS: Using data from a clinical registry linked with Medicare claims, we examined warfarin use at discharge and 30-day and 1-year Kaplan-Meier estimates of all-cause mortality and cumulative incidence rates of mortality, thromboembolic events, myocardial infarction, and bleeding events in patients 65 years or older, with a history of atrial fibrillation and a cardiovascular implantable electronic device admitted with heart failure between 2001 and 2006, who were naïve to anticoagulation therapy at admission. We compared outcomes between patients who were or were not prescribed warfarin at discharge and tested associations between treatment and outcomes. RESULTS: Of 2586 eligible patients in 252 hospitals, 2049 were discharged without a prescription for warfarin. At 1 year, the group discharged without warfarin had a higher mortality rate after discharge (37.4% vs 28.8%; P < 0.001) but similar rates of thromboembolism, myocardial infarction, and bleeding events. After adjustment, treatment with warfarin was associated with lower risk of all-cause death 1 year after discharge (hazard ratio: 0.76, 95% confidence interval: 0.63-0.92). CONCLUSIONS: Among older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device, 4 of 5 were discharged without a prescription for warfarin. Warfarin nonuse was associated with a higher risk of death 1 year after discharge. Clin. Cardiol. 2011 DOI: 10.1002/clc.22064 Damon M. Seils, MA, Duke University, assisted with manuscript preparation. Mr. Seils did not receive compensation for his assistance apart from his employment at the institution where the study was conducted. This study was supported by a research agreement between Duke University and Janssen Pharmaceuticals. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Duke Scholars

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

November 2012

Volume

35

Issue

11

Start / End Page

649 / 657

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Time Factors
  • Thromboembolism
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Patient Discharge
 

Citation

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Hess, P. L., Greiner, M. A., Fonarow, G. C., Klaskala, W., Mills, R. M., Setoguchi, S., … Curtis, L. H. (2012). Outcomes associated with warfarin use in older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device: findings from the ADHERE registry linked to Medicare claims. Clin Cardiol, 35(11), 649–657. https://doi.org/10.1002/clc.22064
Hess, Paul L., Melissa A. Greiner, Gregg C. Fonarow, Winslow Klaskala, Roger M. Mills, Soko Setoguchi, Sana M. Al-Khatib, Adrian F. Hernandez, and Lesley H. Curtis. “Outcomes associated with warfarin use in older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device: findings from the ADHERE registry linked to Medicare claims.Clin Cardiol 35, no. 11 (November 2012): 649–57. https://doi.org/10.1002/clc.22064.
Hess PL, Greiner MA, Fonarow GC, Klaskala W, Mills RM, Setoguchi S, Al-Khatib SM, Hernandez AF, Curtis LH. Outcomes associated with warfarin use in older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device: findings from the ADHERE registry linked to Medicare claims. Clin Cardiol. 2012 Nov;35(11):649–657.
Journal cover image

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

November 2012

Volume

35

Issue

11

Start / End Page

649 / 657

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Time Factors
  • Thromboembolism
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Patient Discharge