1. 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. Background 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. Results 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 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.) Exhibit 1. Baseline Characteristics of Patients Exhibit 2. Factors associated with anticoagulation Exhibit 3. Site-level variation in anticoagulation 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-principal investigators 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. 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 Variable No Anticoagulation (N=58736) Anticoagulation (N=7404) P-value+ Age, median (25 th, 75th), year69.0(57.0, 80.0)70.0 (57.0, 80.0)0.025 Female sex, %50.045.1<0.001 Race White56.961.2<0.001 Black or African American26.023.2 Hispanic8.97.4 Asian1.71.0 Other0.90.8 Unable to determine2.42.1 Insurance, % <0.001 No Insurance/Not Documented6.75.0 Medicare43.343.2 Medicaid11.811.6 Other27.628.4 History of, % Diabetes45.942.2<0.001 Hyperlipidemia42.441.00.034 Hypertension76.869.5<0.001 Peripheral vascular disease9.811.20.003 Coronary artery disease45.348.8<0.001 Prior myocardial infarction17.419.6<0.001 Anemia15.612.2<0.001 Long-term dialysis5.02.9<0.001 Chronic kidney disease20.016.8<0.001 Smoking22.318.5<0.001 Ischemic etiology50.253.7<0.001 Ejection fraction < 35%49.058.6<0.001 Meds Prior to Admission, % ACE inhibitor41.243.50.001 Aldosterone antagonist9.816.0<0.001 Angiotensin receptor blocker15.314.30.039 Aspirin49.439.3<0.001 Beta-Blocker48.450.80.001 Statin43.945.70.011 In-hospital Procedures ICD/CRT-D7.18.8<0.001 CABG0.5 0.484 PTCA1.81.1<0.001 Hospital Characteristics No. of beds in hospital, median (IQR)392 (265, 580)392 (270,581)0.040 Teaching status59.357.9<0.001 Primary PTCA performed for AMI79.977.80.002 Cardiac surgery performed72.270.90.040 Heart transplants performed9.111.7<0.001 Variable Adjusted Odds Ratio (95% Confidence Interval) Prior ICD or CRT-D implantation1.77 (1.63-1.91) Peripheral vascular disease1.21 (1.10-1.33) History of ischemic heart disease1.11 (1.02-1.20) Male1.07 (1.01-1.14) Ejection fraction, per 5 % decrease1.02 (1.01-1.03) Heart rate, per 5 bpm1.02 (1.01-1.03) Age, per 5 years0.97 (0.96-0.98) Systolic blood pressure, per 5 mmHg0.95 (0.94-0.95) Dyslipidemia0.93 (0.88-0.99) Anemia0.91 (0.83-0.99) Diabetes mellitus0.91 (0.85-0.97) Race: Other (reference: white race)0.85 (0.77-0.94) Hypertension0.84 (0.77-0.91) Chronic kidney disease0.82 (0.75-0.90) Lack of health insurance (reference: private insurance)0.81 (0.71-0.93) End-stage renal disease requiring dialysis0.77 (0.65-0.92) Smoking history0.72 (0.66-0.78)