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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

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