title: Anticoagulation therapy in patients with heart failure due to systolic dysfunction and sinus rhythm: analysis of REDINSCOR registry.
abstract: OBJECTIVE
  In patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm without conditions such as atrial fibrillation, thrombus or history of thromboembolic events, the use of anticoagulation is controversial. Our objective was to evaluate the anticoagulation strategy in these patients, variables associated with its use, and its effects on various cardiovascular events.
  
  
  METHODS
  Of the patients included in the REDINSCOR registry with left ventricular ejection fraction ≤35% and sinus rhythm without other anticoagulation indications (including patients with heart failure from 19 Spanish centres), we compared those who received this treatment with the remaining patients.
  
  
  RESULTS
  Between 2007 and 2010, 2263 patients were included, of whom 902 had left ventricular ejection fraction ≤35% and sinus rhythm. Of these, 237 (26%) were receiving anticoagulation therapy. Variables associated with this treatment were a lower left ventricular ejection fraction, ischemic etiology, advanced functional class, wider QRS, larger left atrial diameter, and hospitalization. After 21(11-32) months of median follow-up, there were no significant differences in total mortality (14% versus 12.5%) or stroke (0.8% versus 0.9%). A propensity score adjusted multivariate analysis showed a reduction in a combined end-point including cardiac death, heart transplantation, coronary revascularization, and cardiovascular hospitalization (hazard ratio: 0.74; 95% confidence interval, 0.56-0.97; P=.03) in patients receiving anticoagulation therapy. No information regarding bleeding was collected in the follow-up.
  
  
  CONCLUSIONS
  In a large and contemporary series of patients with heart failure, left ventricular ejection fraction ≤35% and sinus rhythm, 26% received anticoagulation therapy. This was not associated with lower mortality or stroke incidence, although there was a reduction in major cardiac events.
authors.affiliation: Unidad de Insuficiencia Cardiaca, Trasplante e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. patriciaavellana@yahoo.com.ar
authors.forename: Patricia
authors.initials: P
authors.lastname: Avellana
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero
authors.forename: Rafael
authors.initials: R
authors.lastname: Vázquez
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Xavier
authors.initials: X
authors.lastname: Borrás
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpón
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001146:Arrhythmia, Sinus / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology
chemical_list: D000925:Anticoagulants