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, 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; 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 U19HS 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, % <0.001 Race White <0.001 Black or African American Hispanic Asian Other Unable to determine Insurance, % <0.001 No Insurance/Not Documented Medicare Medicaid Other History of, % Diabetes <0.001 Hyperlipidemia Hypertension <0.001 Peripheral vascular disease Coronary artery disease <0.001 Prior myocardial infarction <0.001 Anemia <0.001 Long-term dialysis5.02.9<0.001 Chronic kidney disease <0.001 Smoking <0.001 Ischemic etiology <0.001 Ejection fraction < 35% <0.001 Meds Prior to Admission, % ACE inhibitor Aldosterone antagonist <0.001 Angiotensin receptor blocker Aspirin <0.001 Beta-Blocker Statin In-hospital Procedures ICD/CRT-D7.18.8<0.001 CABG PTCA1.81.1<0.001 Hospital Characteristics No. of beds in hospital, median (IQR)392 (265, 580)392 (270,581)0.040 Teaching status <0.001 Primary PTCA performed for AMI Cardiac surgery performed Heart transplants performed <0.001 Variable Adjusted Odds Ratio (95% Confidence Interval) Prior ICD or CRT-D implantation1.77 ( ) Peripheral vascular disease1.21 ( ) History of ischemic heart disease1.11 ( ) Male1.07 ( ) Ejection fraction, per 5 % decrease1.02 ( ) Heart rate, per 5 bpm1.02 ( ) Age, per 5 years0.97 ( ) Systolic blood pressure, per 5 mmHg0.95 ( ) Dyslipidemia0.93 ( ) Anemia0.91 ( ) Diabetes mellitus0.91 ( ) Race: Other (reference: white race)0.85 ( ) Hypertension0.84 ( ) Chronic kidney disease0.82 ( ) Lack of health insurance (reference: private insurance)0.81 ( ) End-stage renal disease requiring dialysis0.77 ( ) Smoking history0.72 ( )