Dual Pathway Inhibition in Patients with Atherosclerosis with or without Heart Failure: Insights from the XATOA Registry

Abstract

Background

Patients with atherosclerotic cardiovascular disease might benefit from dual pathway inhibition (DPI) therapy, which includes rivaroxaban and aspirin. Patients with concomitant heart failure (HF) are a subgroup with a higher risk for ischemic events. Accordingly, we explored the risks and benefits of DPI therapy in a generalizable population of patients with concomitant atherosclerotic cardiovascular disease and HF.

Methods

The Xarelto plus Acetylsalicylic acid Treatment patterns and Outcomes in patients with Atherosclerosis (XATOA) registry is a prospective, multicentre registry of patients with either coronary artery or peripheral artery disease that were given DPI therapy. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke, and the safety outcome was major bleeding. Multivariable logistic regression was performed to assess the association of HF status and ejection fraction (EF) on the outcomes of interest.

Results

Of 5532 participants, 4022 (72.7%) had documentation of HF status. Of those 873 (21.5%) had a history of HF (EF > 40%, 461; EF ≤ 40%, 181, EF unknown, 231). Over a median follow-up of 465 days (interquartile range, 372-576), the primary outcome occurred in 4.9% of participants with HF compared with 2.4% in those without HF (adjusted hazard ratio, 1.57; 95% confidence interval, 1.02-2.41). The safety outcome was similar in patients with and without HF (0.9% vs 1.11%; a hazard ratio, 0.7; 95% confidence interval, 0.31-1.67).

Conclusions

In a generalizable cohort of patients with atherosclerotic disease and HF, the use of DPI therapy is associated with outcomes similar to those observed in recent randomized controlled clinical trials.