Microsoft word - antitrombotici_hf.doc

European Journal of Heart Failure
Volume 4, Issue 5, October 2002, Pages 647-654
Copyright 2002 European Society of Cardiology. Published by Elsevier Science B.V.
Antithrombotic therapy is associated with better survival in
patients with severe heart failure and left ventricular systolic
dysfunction (EPICAL study)

M. Echemanna, b, F. Allaa, b, S. Briançona, Y. Juillièrec, J. M. Viriona, b, P. M. Mertèsc, J. P.
Villemotc, F. Zannad, b, c, d and on behalf of the EPICAL Investigatorse

a Service d'Epidémiologie et d'Evaluation cliniques, Hôpital Marin, CHU, Nancy, France
b Centre d'Investigation Clinique (CIC-INSERM), CHU, Nancy, France c Services de Cardiologie et de Chirurgie Cardiaque, CHU, Nancy, France d Thérapeutique-Faculté de Médecine, Université Henri Poincaré, Nancy, France e Participating Hospitals in, Lorraine, France Received 19 July 2001; revised 5 October 2001; accepted 17 December 2001. Available online 2 May 2002. Abstract
Background: In patients with congestive heart failure (CHF), clinical trials have demonstrated the
benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published
controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work
was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy,
and survival of CHF patients in current clinical practice, using an observational, population-based
Methods: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has
identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion
criteria were age 20¯80 years in 1994, at least one hospitalisation for cardiac decompensation,
NYHA III/IV HF, ventricular ejection fraction 30% or cardiothoracic index 60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. Results: Duration of disease >1 year, renal failure, serum sodium 138 mmol/l, old age, serious
comorbidity, previous decompensation, high doses of furosemide and vasodilators use were
independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid
lowering drugs and beta-blockers use were associated with better survival. There was no interaction
between aspirin and angiotensin converting enzyme inhibitor use on survival.
Conclusion: Antithrombotic therapy was associated with a better long-term survival in our study
population of severe CHF. These results together with other previously published circumstantial
evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate
optimal oral anticoagulants and aspirin in patients with congestive heart failure.
Author Keywords: Severe heart failure; Antithrombotic treatment; Survival; Epidemiology


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