Heart Failure and Warfarin

By: Alere Staff

About 5.1 million people in the United States live with a medical condition called heart failure.This is a chronic condition in which the heart muscle is weakened and unable to supply the body with enough oxygen-rich blood. This can result in symptoms of fatigue, shortness of breath and fluid retention.2 Many people with heart failure lead productive, full lives when managed with proper medications and lifestyle changes.  

People who typically report success and reduction of symptoms of heart failure are those who take an active role in the management of their chronic condition. Building new habits, such as eating better, exercising as directed by their healthcare provider and tracking and monitoring symptoms are beneficial to improving physical and emotional well-being. Discuss with your doctor or dietician recommended dietary changes that will most impact your heart failure, such as a reduction in salt intake and an increase in fresh fruits and vegetables, healthy proteins like poultry and fish, whole grains and healthy fats like olive oil. Since the heart is a muscle, regular exercise can increase the overall strength of the heart. Your doctor may recommend a regular exercise program to help achieve these goals. Monitoring your weight and symptoms daily can help to prevent admission to the hospital. Talk to your healthcare team about when to report symptoms.3

Atrial fibrillation, an irregular heart rhythm, affects about 10 to 30 percent of people with heart failure.3  The combination of heart failure and atrial fibrillation places an individual at higher risk for complications, including thromboembolism, or blood clots. Anticoagulation with medications such as warfarin is recommended for the prevention of blood clots in the setting of heart failure and atrial fibrillation.4 The benefits of anticoagulation depend on maintaining appropriate international normalized ratio, or INR, levels.5 It is not clear if heart failure actually affects the INR levels, so it is important to have your INR tested regularly, as directed by your doctor. Studies show that compliance with INR monitoring can reduce the incidence of hospital readmissions for people with heart failure and atrial fibrillation.6

For people with heart failure, more frequent monitoring of the INR levels may be beneficial in achieving and maintaining target INR levels.


  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.
  2. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp.
  3. Stevenson WG, Stevenson LW. Atrial fibrillation in heart failure (editorial comment). N Engl J Med. 1999;341:910–1.
  4. Fonarow GC, Heywood JT, Heidenreich PA, et al. Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2007;153: 1021–8.
  5. http://circoutcomes.ahajournals.org: Associations Between Anticoagulation Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Atrial Fibrillation.
  6. http://dx.doi.org/10.1016/j.cardfail.2012.06.354; Early International Normalized Ratio (INR) Monitoring and Long-Term Clinical Outcomes in Warfarin Users with Heart Failure: Findings from ADHERE Linked with Medicare Claims Laura G. Qualls; Melissa A. Greiner; Zubin J. Eapen; Gregg C. Fonarow; Roger M. Mills; Winslow Klaskala; Adrian F. Hernandez; Lesley H. Curtis.