Limited evidence from r and omized trials and observational studies found a reduction in mortality and cardiovascular events with anticoagulants compared to controls .
Although oral anticoagulation is indicated in certain groups of patients with heart failure ( e.g. atrial fibrillation ) , the available data do not support its routine use in heart failure patients who remain in sinus rhythm
BACKGROUND Patients with chronic heart failure ( heart failure ) are at risk of thromboembolic events , and coronary ischaemic events also contribute to the progression of heart failure .
Long-term oral anticoagulation is established in certain groups , including patients with heart failure and atrial fibrillation , but there is wide variation in the use of oral anticoagulation in the broader heart failure population .
OBJECTIVE To determine whether long-term oral anticoagulation reduces total deaths and /or major thromboembolic events in patients with heart failure .
Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS).
To evaluate the influence of the angiotensin-converting-enzyme inhibitor enalapril ( 2.5 to 40 mg per day ) on the prognosis of severe congestive heart failure ( New York Heart Association [ NYHA ] functional class IV ) , we r and omly assigned 253 patients in a double-blind study to receive either placebo ( n = 126 ) or enalapril ( n = 127 ) . Conventional treatment for heart failure , including the use of other vasodilators , was continued in both groups . Follow-up averaged 188 days ( range , 1 day to 20 months ) . The crude mortality at the end of six months ( primary end point ) was 26 percent in the enalapril group and 44 percent in the placebo group -- a reduction of 40 percent ( P = 0.002 ) . Mortality was reduced by 31 percent at one year ( P = 0.001 ) . By the end of the study , there had been 68 deaths in the placebo group and 50 in the enalapril group -- a reduction of 27 percent ( P = 0.003 ) . The entire reduction in total mortality was found to be among patients with progressive heart failure ( a reduction of 50 percent ) , whereas no difference was seen in the incidence of sudden cardiac death . A significant improvement in NYHA classification was observed in the enalapril group , together with a reduction in heart size and a reduced requirement for other medication for heart failure . The overall withdrawal rate was similar in both groups , but hypotension requiring withdrawal occurred in seven patients in the enalapril group and in no patients in the placebo group . After the initial dose of enalapril was reduced to 2.5 mg daily in high-risk patients , this side effect was less frequent . We conclude that the addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms . The beneficial effect on mortality is due to a reduction in death from the progression of heart failure
Limited evidence from r and omized trials and observational studies found a reduction in mortality and cardiovascular events with anticoagulants compared to controls .
Although oral anticoagulation is indicated in certain groups of patients with heart failure ( e.g. atrial fibrillation ) , the available data do not support its routine use in heart failure patients who remain in sinus rhythm
BACKGROUND Patients with chronic heart failure ( heart failure ) are at risk of thromboembolic events , and coronary ischaemic events also contribute to the progression of heart failure .
Long-term oral anticoagulation is established in certain groups , including patients with heart failure and atrial fibrillation , but there is wide variation in the use of oral anticoagulation in the broader heart failure population .
OBJECTIVE To determine whether long-term oral anticoagulation reduces total deaths and /or major thromboembolic events in patients with heart failure .