Use of aspirin in conjunction with angiotensin-converting enzyme inhibitors does not worsen long-term survival in heart failure.

BACKGROUND: A negative interaction has been shown to exist between aspirin and angiotensin-converting enzyme inhibitors (ACE-I) in subjects with heart failure. We explored the effect of combined ACE-I and aspirin therapy compared to ACE-I without aspirin on clinical outcomes in patients with heart failure.

METHODS: 430 consecutive subjects (70+/-14 years, 55% male, 41% with coronary artery disease) released from the hospital with a primary diagnosis of heart failure were classified into three groups based on the use of aspirin and ACE-I at discharge: ACE-I without aspirin (group I, n=134), ACE-I with aspirin (group II, n=138) and no ACE-I (group III, n=158). Follow-up (all-cause mortality and the composite end-point of mortality or emergent heart transplant) was available in 406 (94%) patients at a median duration of 28 months. Differences in outcomes between patient groups were compared using contingency tables, Kaplan-Meier survival, and Cox regression analyses. Similar analyses were conducted in four predefined subsets (patients with and without coronary artery disease, and those with left ventricular ejection fraction 45%).

RESULTS: Death and the composite end-point occurred in 155 (38%) and 165 (41%) patients, respectively. In the total cohort as well as in the four subsets, the treatment group showed no association with clinical outcomes in univariate or multivariate analyses.

CONCLUSIONS: In patients with a principal discharge diagnosis of heart failure, the use of aspirin, in combination with ACE-I, does not worsen long-term survival compared to the use of ACE-I without aspirin.