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

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 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.