Improved Survival in Heart Failure Associated with Aspirin Alone or in Combination with ACE Inhibition: An Observational Study

Background: The appropriate role of aspirin in heart failure is controversial. Retrospective analyses have suggested the use of aspirin may attenuate the benefit seen with angiotensin converting enzyme inhibitor (ACEI) therapy. This study investigates the relationship between aspirin use and survival in the UNC Heart Failure Database. This cohort has substantially greater representation of women (32%), African-Americans (44%), and patients with heart failure of a non-ischemic etiology (68%) than previously examined populations. Methods: Data from 872 patients with symptomatic heart failure (HF) and systolic dysfunction were reviewed. These patients were enrolled in the UNC Heart Failure Database from 1984 through 1999, and were followed for a mean of 3.7 years. Data on vital status, available in 96% of patients, revealed 392 deaths. The Cox proportional-hazards regression method was used to determine the relationship of baseline characteristics to all-cause mortality. Results: Multivariate, adjusted survival analysis indicated aspirin use at baseline was associated with a significant reduction in all-cause mortality, with a hazard ratio (HR) for aspirin use of 0.71 (95% CI 0.55-0.92). In patients taking ACEI at baseline, the HR for aspirin use was 0.76 (0.57-1.01) compared to a HR of 0.61 (0.31-1.19) for those not taking ACEI. In patients with ischemic heart disease (IHD) as their primary HF etiology, the HR for aspirin use was 0.65 (0.46-0.94) compared to a HR of0.93 (0.64-1.34) for those with a primary HF etiology other than IHD. Conclusion: Aspirin use at baseline in patients with symptomatic heart failure was independently associated with reduced all-cause mortality.Master of Public Healt