PS1586 EFFECT OF ORAL ANTICOAGULANT TREATMENT ON THE MORTALITY OF PATIENTS WITH ACUTE HEART FAILURE: ANALYSIS BY PROPENSITY SCORE MATCHING
Authors: Fernandez‐Rodriguez M.A. , Miró O. , Llorens P. , Martín‐Sanchez F.J. , Gil V. , Jacob J. , Morais L.R. , Castañón C. , Herrero‐Puente P. 
Published: June 2019

Background:

Heart failure is associated with activation of thrombin‐related pathways, which predicts a poor prognosis, this activation may contribute to disease progression by inducing inflammation, endothelial dysfunction, and arterial and venous thrombosis. Besides, Atrial Fibrillation, one of the most important indications of anticoagulant treatment appears frecuently in patients with heart failure.

Aims:

To analyse the influence of the previous treatment with oral anticoagulants in the early mortality in patients with acute heart failure.

Methods:

Multicenter, prospective cohort study of consecutive inclusion of patients with acute heart failure (AHF) attended in Spanish SUH. The diagnosis of AHF was made based on criteria of the European Society of Cardiology. They were divided according to whether they were receiving home treatment with oral anticoagulants (ANTICAGULATED group) or not (CONTROL group). The dependent variable was mortality at 30 days and a year. Variables: Age and sex, systolic blood pressure (PAS), cardiac and respiratory frequencies and oxygen basal arterial saturation, cardiovascular risk factors and previous cardiovascular diseases, basal NHYA and episode, clinical episode data, Analytical and ECG parameters, Troponins, natriuretic peptides, hospital admission and CHADS‐Vasc.

Statistical analysis: Comparison of proportions by Chi‐square, averages by T‐student and multivariate analysis by logistic regression and survival through the Cox method and pairing through a propensity score between the two groups of Treatment, adjusting by the variables with p < 0.05 in the Bivariate analysis and controlling the reference hospital.

Results:

13366 patients with AHF were included, in treatment with oral anticoagulants 5471 (39.7%). In the ANTICOAGULATED‐group there are more comorbility (hypertension, diabetes, ischemic cardiopathy, valvular cardiopathy, atrial fibrillation, cerebro‐vascular disease and previous heart failure). They have poor functional status to disnea (NYHA III‐IV) and more frailty.

The clinical data of the acute episode were less severe in the anticoagulated group and had lower values of NT‐ProBNP and Troponins. OR (IC95%) Crude and adjusted mortality to 30 days is 0.64 (IC95% 0.54–0.77) and 0.69 (IC95% 0.54–0.89) and for the annual mortality 0.78 (IC95% 0.69–0.87) and 0.71 (IC95% 0.60–0.84) crude and adjusted respectively. After the propensity Score matching 2330 patients were matched without any difference between them in the analyzed variables. The Hazard Ratio (HR) (IC95%) For the 30‐day mortality of oral anticoagulant therapy is 0.66 (IC95% 0.50–0.85) and for annual mortality 0.79 (IC95% 0.68–0.92).

Summary/Conclusion:

Treatment with oral anticoagulants in patients with AHF is related to a lower early and annual mortality independently of the differences between the two groups of patients. This may be due to the effect of this treatment on the state of hypercoagulation described in patients with this pathology.