International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists

Enrique Santas, Gema Miñana, Jana Gummel, Roxana Farcasan, Ana Payá, Raquel Heredia, Vicent Bodí, Anna Mollar, Vicente Bertomeu-González, Francisco Javier Chorro, Juan Sanchis, Josep Lupón, Antoni Bayés Genís, Julio Núñez

Research output: Contribution to journalArticleResearch

Abstract

© 2018 Sociedad Española de Cardiología Introduction and objectives: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. Methods: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR < 2, n = 660), and supratherapeutic (INR > 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, restricted mean survival time differences were used to evaluate the association among INR categories and the risk of all-cause mortality. Results: During a median [interquartile range] follow-up of 2.15 years [0.71-4.29], 495 (43.5%) patients died. On multivariable analysis, both patients with subtherapeutic and supratherapeutic INR showed higher risks of all-cause mortality, as evidenced by their restricted mean survival time differences at 5 years’ follow-up: –0.50; 95%CI, –0.77 to –0.23 years; P <.001; and –0.40; 95%CI, –0.70 to –0.11 years; P =.007, respectively, compared with INR 2-3. Conclusions: In acute heart failure patients on treatment with VKA for NVAF, INR values out of normal range at admission were independently associated with a higher long-term mortality risk.
Original languageEnglish
Pages (from-to)616-624
JournalRevista Espanola de Cardiologia
Volume72
DOIs
Publication statusPublished - 1 Aug 2019

Keywords

  • Atrial fibrillation
  • Heart failure
  • International normalized ratio

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