title: Associations between anticoagulation therapy and risks of mortality and readmission among patients with heart failure and atrial fibrillation.
abstract: BACKGROUND
  Patients with heart failure and atrial fibrillation are at higher risk of thromboembolic events than patients with heart failure alone. Yet, the use of anticoagulation therapy varies in clinical practice, especially among older patients, for whom its effectiveness is poorly understood.
  
  
  RESULTS
  Using clinical registry data linked to Medicare claims from 2005 to 2011, we examined outcomes of older patients hospitalized with heart failure and atrial fibrillation who newly initiated anticoagulation therapy at discharge. We used Cox proportional hazards models and inverse probability-weighted treatment estimates to adjust for selection bias. Main outcomes were mortality and readmission at 1 and 3 years. Among 5105 patients in 195 hospitals, 1623 (31.8%) started anticoagulation therapy at discharge. Treated patients had lower unadjusted rates of all-cause mortality (26.4% versus 42.8%; P<0.001) and all-cause readmission (58.4% versus 63.7%; P<0.001) at 1 year. After inverse weighting for the probability of treatment and adjustment for other discharge medications, anticoagulation therapy was associated with significantly lower 1-year mortality (hazard ratio, 0.70; 99% confidence interval, 0.59-0.82), but there was no statistically significant difference in the risk of all-cause readmission (hazard ratio, 0.89; 99% confidence interval, 0.78-1.01) or other readmission outcomes. Results were similar at 3 years.
  
  
  CONCLUSIONS
  Initiation of anticoagulation therapy at hospital discharge was associated with improved mortality at 1 and 3 years but was not associated with improved cardiovascular readmission among older patients with heart failure and atrial fibrillation.
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.). adrian.hernandez@duke.edu.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Laura G
authors.initials: LG
authors.lastname: Qualls
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: From the Duke Clinical Research Institute (A.F.H., L.L., B.G.H., L.G.Q., S.M.A.-K., J.P.P., L.H.C.) and Department of Medicine (A.F.H., S.M.A.-K., J.P.P., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H.); and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015588:Observer Variation; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; atrial fibrillation; heart failure; outcome assessment (health care)