PMID- 30037426
OWN - NLM
STAT- MEDLINE
DCOM- 20190816
LR  - 20190901
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 122
IP  - 5
DP  - 2018 Sep 1
TI  - Heart Failure Severity and Quality of Warfarin Anticoagulation Control (From the 
      WARCEF Trial).
PG  - 821-827
LID - S0002-9149(18)31196-2 [pii]
LID - 10.1016/j.amjcard.2018.05.024 [doi]
AB  - Previous studies in patients with atrial fibrillation showed that a history of 
      heart failure (HF) could negatively impact anticoagulation quality, as measured 
      by the average time in therapeutic range (TTR). Whether additional markers of HF 
      severity are associated with TTR has not been investigated thoroughly. We aimed 
      to examine the potential role of HF severity in the quality of warfarin control 
      in patients with HF with reduced ejection fraction. Data from the Warfarin versus 
      Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the 
      association between TTR and HF severity. Multivariable logistic regression models 
      were used to examine the association of markers of HF severity, including New 
      York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and 
      frequency of HF hospitalization, with TTR >/=70% (high TTR). We included 1,067 
      participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted 
      analysis, patients with a high TTR were older and less likely to have had strokes 
      or receive other antiplatelet agents. Those patients also had lower NYHA class, 
      better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF 
      hospitalizations. Multivariable analysis showed that NYHA class III and/or IV 
      (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 
      10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 
      0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 
      [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In 
      HF patients with systolic dysfunction, NYHA class III and/or IV, poor 
      health-related quality of life, and a higher rate of HF hospitalization were 
      independently associated with suboptimal quality of warfarin anticoagulation 
      control. These results affirm the need to assess the new approaches, such as 
      direct oral anticoagulants, to prevent thromboembolism in this patient 
      population.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Lee, Tetz C
AU  - Lee TC
AD  - Columbia University Irving Medical Center, New York, New York. Electronic 
      address: sl4190@columbia.edu.
FAU - Qian, Min
AU  - Qian M
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Lip, Gregory Y H
AU  - Lip GYH
AD  - Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, 
      United Kingdom.
FAU - Di Tullio, Marco R
AU  - Di Tullio MR
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Graham, Susan
AU  - Graham S
AD  - The State University of New York at Buffalo, Buffalo, New York.
FAU - Mann, Douglas L
AU  - Mann DL
AD  - Washington University School of Medicine, St. Louis, Missouri.
FAU - Nakanishi, Koki
AU  - Nakanishi K
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Teerlink, John R
AU  - Teerlink JR
AD  - Section of Cardiology, San Francisco Veterans Affairs Medical Center and School 
      of Medicine, University of California San Francisco, San Francisco, California.
FAU - Freudenberger, Ronald S
AU  - Freudenberger RS
AD  - Lehigh Valley Hospital, Allentown, Pennsylvania.
FAU - Sacco, Ralph L
AU  - Sacco RL
AD  - The University of Miami, Miami, Florida.
FAU - Mohr, J P
AU  - Mohr JP
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Labovitz, Arthur J
AU  - Labovitz AJ
AD  - The University of South Florida, Tampa, Florida.
FAU - Ponikowski, Piotr
AU  - Ponikowski P
AD  - Military Hospital, Wroclaw, Poland.
FAU - Lok, Dirk J
AU  - Lok DJ
AD  - Deventer Hospital, Deventer, The Netherlands.
FAU - Estol, Conrado
AU  - Estol C
AD  - Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina.
FAU - Anker, Stefan D
AU  - Anker SD
AD  - Division of Cardiology and Metabolism, Department of Cardiology; and 
      Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum fur 
      Herz-Kreislauf-Forschung partner site Berlin; Charite Universitatsmedizin Berlin, 
      Germany; Department of Cardiology and Pneumology, University Medicine Gottingen, 
      Gottingen, Germany.
FAU - Pullicino, Patrick M
AU  - Pullicino PM
AD  - Kent Institute of Medicine and Health Science, Canterbury, United Kingdom.
FAU - Buchsbaum, Richard
AU  - Buchsbaum R
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Levin, Bruce
AU  - Levin B
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Thompson, John L P
AU  - Thompson JLP
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Homma, Shunichi
AU  - Homma S
AD  - Columbia University Irving Medical Center, New York, New York.
FAU - Ye, Siqin
AU  - Ye S
AD  - Columbia University Irving Medical Center, New York, New York.
CN  - WARCEF Investigators
LA  - eng
GR  - K23 HL121144/HL/NHLBI NIH HHS/United States
GR  - U01 NS039143/NS/NINDS NIH HHS/United States
GR  - U01 NS043975/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20180604
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - R16CO5Y76E (Aspirin)
MH  - Anticoagulants/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Atrial Fibrillation/drug therapy
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality of Life
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Thromboembolism/*prevention & control
MH  - Treatment Outcome
MH  - Warfarin/*therapeutic use
PMC - PMC6151139
MID - NIHMS972620
COIS- Conflict of interest Dr. Anker reports consultancy for Janssen (minor) - steering 
      committee for COMMANDER-HF. Dr. Homma reports being a consultant for St. Jude 
      Medical, Daiichi-Sankyo, Bristol Meyers Squibb, Pfizer. Dr. Labovitz has received 
      a research grant from Bristol-Myers Squibb/Pfizer for the AREST trial. Dr. Lip 
      has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi, 
      BMS/Pfizer, Biotronik, Portola, and Boehringer Ingelheim and has been on the 
      speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi-Aventis. 
      Dr. Sacco has received research grants from NINDS, NCATS, AHA, Evelyn McKnight 
      Brain Foundation and Boehringer Ingelheim. Dr. Teerlink has received consulting 
      fees/research grants from Actelion, Amgen, Bayer, Cytokinetics, Medtronic, 
      Novartis, St. Jude, Trevena. The other authors have no relationships to report.
EDAT- 2018/07/25 06:00
MHDA- 2019/08/17 06:00
PMCR- 2019/09/01
CRDT- 2018/07/25 06:00
PHST- 2018/03/23 00:00 [received]
PHST- 2018/05/07 00:00 [revised]
PHST- 2018/05/07 00:00 [accepted]
PHST- 2018/07/25 06:00 [pubmed]
PHST- 2019/08/17 06:00 [medline]
PHST- 2018/07/25 06:00 [entrez]
PHST- 2019/09/01 00:00 [pmc-release]
AID - S0002-9149(18)31196-2 [pii]
AID - 10.1016/j.amjcard.2018.05.024 [doi]
PST - ppublish
SO  - Am J Cardiol. 2018 Sep 1;122(5):821-827. doi: 10.1016/j.amjcard.2018.05.024. Epub 
      2018 Jun 4.