PB0506 - Patient characteristics associated with arterial thromboembolism in incident hospitalized heart failure patients without other known indications for antithrombotic treatment: A nationwide cohort study

Background: It is controversial whether heart failure (HF) patients in sinus rhythm without prior thromboembolism or known cardioembolic source would benefit from anticoagulation.

Aims: To explore patient characteristics associated with developing arterial thromboembolism in incident hospitalized HF patients without other known indications for antithrombotic treatment.

Methods: With nationwide data from Statistics Netherlands, we identified all adult patients admitted to hospitals with newly developed HF (ICD-10 code: I50) in 2018, but only included those who were without atrial fibrillation, rheumatic mitral stenosis/mechanical heart valves, venous thromboembolism, myocardial infarction, ischemic stroke/transient ischemic attack/systemic arterial thromboembolism (ATE), and peripheral artery disease within the prior 5 years, and who did not receive antithrombotic agents within the prior 6 months. All included patients were followed for 1 year (or until death), and ATE was the study outcome. Cumulative incidences and hazard ratios of the outcome were estimated by the cumulative incidence competing risk method and Cox regression respectively among patients with different baseline characteristics.

Results: Among ≈41,000 incident HF patients in 2018 in The Netherlands, 6,199 (14.8%) were included (mean age 71.47±15.40 years; 42.9% male). The five most prevalent comorbidities were hypertension (36.0%), other valvular heart disease (22.2%), diabetes (21.1%), chronic obstructive pulmonary disease (19.7%), and abnormal renal function (19.1%). 140 patients developed ATE within 1 year with a cumulative incidence of 2.26% (95% confidence interval 1.91-2.65%). Old age, male sex, low income, and comorbidities including hypertension, aortic plaque, coagulopathy, and diabetes appeared to be risk factors of developing ATE (see the Figures).

Conclusion(s): The absolute risk of ATE appeared to be relatively low in HF patients who were without other indication for antithrombotic treatment when HF was diagnosed, among whom old age, male sex, low income and several comorbidities appeared to be risk factors.