title: Antithrombotic therapies in patients with heart failure: hypothesis formulation from a research database.
abstract: OBJECTIVE
  Heart failure is a significant public health problem. The present study is intended to explore in a research database whether antithrombotic therapies (ATTs) affect cardiovascular outcomes in patients with incident heart failure (IHF).
  
  
  METHODS
  Using the United Kingdom Health Improvement Network research database, several multivariable models (including logistic and Cox's regression models, as well as propensity score methods) were used to examine all-cause mortality and clinical outcomes among five treatment groups.
  
  
  RESULTS
  The cohort included 24,554 patients with IHF (50.2% men), with a mean age (standard deviation [SD]) of 76.4 (11.0) years. Nearly three-fourths of patients received at least one form of ATT. Patients receiving ATTs tended to be younger and more likely to be men, and had more cardiovascular comorbidities. During the 18-month follow-up period, the mortality rates were 11.1%, 14.6%, 17.8%, 19.5%, and 32.6% for warfarin combination therapy, warfarin alone, clopidogrel therapy, aspirin (ASA) alone, and no therapy, respectively, yielding odds ratios (95%confidence intervals [CI]) relative to no therapy of 0.28 (0.24, 0.33), 0.38 (0.34, 0.43), 0.46 (0.40, 0.52), and 0.49 (0.45, 0.53) for each therapy group, accordingly. The use of ATTs also appeared to be associated with a reduced risk for ischemic or thrombotic events.
  
  
  CONCLUSIONS
  These data contribute to the formulation of the hypothesis that use of ATTs in clinical practice decreases the risk of morbidity and mortality in patients with IHF, although findings require further confirmative studies.
authors.affiliation: Pharmaceutical Research and Development, Johnson and Johnson, Raritan, NJ 08879, USA.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Yuan
authors.forename: Rachel
authors.initials: R
authors.lastname: Weinstein
authors.forename: John
authors.initials: J
authors.lastname: Zhang
authors.forename: Mei
authors.initials: M
authors.lastname: Cheng
authors.forename: George
authors.initials: G
authors.lastname: Griffin
authors.forename: Robert
authors.initials: R
authors.lastname: Zolynas
authors.forename: Alexei N
authors.initials: AN
authors.lastname: Plotnikov
authors.forename: Mary S
authors.initials: MS
authors.lastname: Lee
authors.forename: Leonard
authors.initials: L
authors.lastname: Oppenheimer
authors.forename: Paul
authors.initials: P
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012737:Sex Factors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006113:United Kingdom / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin