title: Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).
abstract: BACKGROUND
  In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database.
  
  
  METHODS
  The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors.
  
  
  RESULTS
  Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival.
  
  
  CONCLUSIONS
  Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.
authors.affiliation: Service d'Epidémiologie et d'Evaluation cliniques, Hôpital Marin, CHU Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: Echemann
authors.forename: F
authors.initials: F
authors.lastname: Alla
authors.forename: S
authors.initials: S
authors.lastname: Briançon
authors.forename: Y
authors.initials: Y
authors.lastname: Juillière
authors.forename: J M
authors.initials: JM
authors.lastname: Virion
authors.forename: P M
authors.initials: PM
authors.lastname: Mertès
authors.forename: J P
authors.initials: JP
authors.lastname: Villemot
authors.forename: F
authors.initials: F
authors.lastname: Zannad
authors.forename: E
authors.initials: E
authors.lastname: Aliot
authors.forename: Ch
authors.initials: Ch
authors.lastname: Breton
authors.forename: K
authors.initials: K
authors.lastname: KhalifE
authors.forename: J L
authors.initials: JL
authors.lastname: Neimann
authors.forename: S
authors.initials: S
authors.lastname: Allam
authors.forename: Ph
authors.initials: P
authors.lastname: Admant
authors.forename: N
authors.initials: N
authors.lastname: Baille
authors.forename: Ph
authors.initials: P
authors.lastname: Bellanger
authors.forename: R
authors.initials: R
authors.lastname: D'Hôtel
authors.forename: P
authors.initials: P
authors.lastname: Dambrine
authors.forename: J F
authors.initials: JF
authors.lastname: Dodet
authors.forename: M
authors.initials: M
authors.lastname: Graille
authors.forename: M
authors.initials: M
authors.lastname: Kessler
authors.forename: G
authors.initials: G
authors.lastname: Rebeix
authors.lastname: Royer
authors.forename: J P
authors.initials: JP
authors.lastname: Saulnier
authors.forename: J Y
authors.initials: JY
authors.lastname: Thisse
authors.forename: B
authors.initials: B
authors.lastname: Trutt
authors.forename: Ph
authors.initials: P
authors.lastname: Vidal
authors.forename: M Ch
authors.initials: MCh
authors.lastname: Vuillemin
authors.lastname: Delahaye
authors.forename: P
authors.initials: P
authors.lastname: Ducimetière
authors.forename: F
authors.initials: F
authors.lastname: Fagnani
authors.forename: L
authors.initials: L
authors.lastname: Guize
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013599:Systole / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents; D001241:Aspirin