HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JACC Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Massie, B. M. Search for Related Content PubMed PubMed Citation Articles by Massie, B. M.

FOCUS ISSUE: ASPIRIN: VIEWPOINT

Aspirin Use in Chronic Heart Failure

What Should We Recommend to the Practitioner?

Barry M. Massie, MD^_*,,_*

^_* Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, California
Cardiology Division, San Francisco VAMC, San Francisco, California.

Manuscript received August 2, 2004; revised manuscript received October 14, 2004, accepted October 25, 2004.

^_* Reprint requests and correspondence: Dr. Barry M. Massie, Cardiology Division (111C), San Francisco VAMC, 4150 Clement Street, San Francisco, California 94121. (Email: barry.massie{at}med.va.gov).

There has been ongoing controversy as to whether aspirin should be used in patients with chronic heart failure (CHF). The argument for aspirin is that many patients have underlying coronary disease, and aspirin prevents reinfarction and other vascular events. Arguments against the routine use of aspirin are that many CHF patients do not have underlying coronary disease, and that the benefit of aspirin lessens after the first 6 to 12 months after infarction. Also, several analyses suggest that aspirin may actually worsen outcomes in CHF patients, possibly because it inhibits prostaglandins, with resulting adverse hemodynamic and renal effects. Two recent prospective randomized studies have found that aspirin is associated with more frequent hospitalizations for worsening heart failure, although it did not have an adverse effect on vascular events. These results suggest that aspirin should not be routinely used in CHF patients and be avoided in those with refractory CHF, but that it may be beneficial in patients with recent infarction or multiple vascular risk factors.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CAD = coronary artery disease   CHF = chronic heart failure   MI = myocardial infarction   NSAIDs = non-steroidal anti-inflammatory drugs   SOLVD = Studies Of Left Ventricular Dysfunction   WASH = Warfarin/Aspirin Study in Heart Failure   WATCH = Warfarin and Antiplatelet Therapy in Chronic Heart Failure trial

Related articles in JACC:

Aspirin Use in Older Patients With Heart Failure and Coronary Artery Disease: National Prescription Patterns and Relationship With Outcomes

Frederick A. Masoudi, Pam Wolfe, Edward P. Havranek, Saif S. Rathore, JoAnne M. Foody, and Harlan M. Krumholz
JACC 2005 46: 955-962. [Abstract] [Full Text]  

This article has been cited by other articles:

				A. Nair, B. Sealove, J. L. Halperin, G. Webber, and V. Fuster Anticoagulation in patients with heart failure: who, when, and why? Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E32 - E38. [Abstract] [Full Text] [PDF]

				F. A. McAlister, W. A. Ghali, Y. Gong, J. Fang, P. W. Armstrong, and J. V. Tu Aspirin Use and Outcomes in a Community-Based Cohort of 7352 Patients Discharged After First Hospitalization for Heart Failure Circulation, June 6, 2006; 113(22): 2572 - 2578. [Abstract] [Full Text] [PDF]