Patients with HF have increased risk for thrombotic events.

1. Prescribing Warfarin at Discharge for Heart Failure Patients: Findings from the Get With The Guidelines-Heart Failure Registry Zubin J. Eapen, Maria Grau-Sepulveda, Gregg C. Fonarow, Paul A. Heidenreich, Eric D. Peterson, Adrian F. Hernandez From the Duke Clinical Research Institute, Durham, NC (Z.J.E, M.G., E.D.P., A.F.H.), University of California Los Angeles, Los Angeles, CA (G.C.F.), Palo Alto VA Medical Center, Palo Alto, California (P.A.H.) Background Results Exhibit 1. Baseline Characteristics of Patients Exhibit 2. Factors associated with anticoagulation • Patients with HF have increased risk for thrombotic events. • However, the net clinical benefit of anticoagulation in a HF population in sinus rhythm has not been supported. • The real-world prevalence and variation in warfarin prescription for HF patients in the absence of established indications is unknown. Objectives • Using data from the AHA’s Get With The Guidelines®-Heart Failure (GWTG-HF) Registry, we sought to determine the prevalence and variation, as well as patient characteristics, in warfarin prescription among a real-world HF population. Methods • Inclusion criteria • Patients discharged home from hospitals in the Get With The Guidelines-Heart Failure registry between January 1, 2005, and September 30, 2011. • Exclusion criteria • Contraindications to warfarin, history of AF, history of CVA/TIA, history of valvular heart disease, in-hospital valve surgery, in-hospital deaths, incomplete discharge data • Statistical analysis • We compared patient and hospital characteristics among patients with and without anticoagulation prescription at discharge. • To evaluate hospital variation, we compared observed rates of anticoagulation at discharge for hospitals with 10 or more patients • Logistic regression models using the generalized estimating equation were developed to identify factors associated with warfarin prescription at discharge. Exhibit 3. Site-level variation in anticoagulation Limitations • Findings from GWTG-HF hospitals may not be generalizable to all hospitals • Data are dependent on the quality of medical record documentation and chart abstraction • Indications not captured: ventricular thrombus, hypercoagulable state, prior thromboembolic events • Contraindications not captured: hemorrhagic tendencies, vascular aneurysm, recent procedures, blood dyscrasias, pregnancy Conclusions • Warfarin was prescribed at discharge in more than 1 out of 10 HF patients without evident indications or contraindications for anticoagulation • Prescription rates vary widely across hospitals Contact Zubin J. Eapen, MD; Duke Clinical Research Institute, Durham, NC 27705; zubin.eapen@duke.edu Disclosures – ZJE, MG, PAH: no relevant disclosures; GCF:research support from the NHLBI and AHRQ (both significant), consulting for Novartis (significant), Gambro (significant), and Medtronic (modest); EDP,:co-principalinvestigators of the Data Analytic Center for AHA GWTG Program, AH: research support from the NHLBI, AHRQ, Amylin, Johnson & Johnson, Portola Pharmaceuticals (significant), consulting for Astra Zeneca (Modest), Corthera (significant), Sanofi (modest) and Bristol Myers Squib (modest). Funding Source – This work was supported by an award from the American Heart Association Pharmaceutical Roundtable, David and Stevie Spina, and an American Heart Association Council on Clinical Cardiology Young Investigator Database Research Seed Grant. This project was also supported in part by grant number U19HS021092 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.