Response to Mei et al. regarding the incidence and predictors of hospitalization for heart failure among patients with stable atherosclerosis in the TRA 2°P‐TIMI 50 trial

[...]in our trial-based analysis, despite a larger (~8-fold) gradient of HHF risk, patients with pre-existing heart failure actually had a lower cumulative HHF incidence in our study (3.8%/year) than was observed by Malik and colleagues among those with no HHF in the preceding 6 months (7.3%/year for HFpEF; 9.7%/year for HFrEF). Since first and recurrent heart failure events are related, a total events analysis would be unlikely to produce a change of the magnitude needed to show a benefit. With regard to the use of antithrombotic therapy in patients with heart failure, the 2021 European Society of Cardiology (ESC) Guidelines cite a subgroup analysis of the COMPASS trial which showed that low-dose rivaroxaban has consistent benefit with respect to reducing MACE in patients with PAD and/or CAD and concomitant HFpEF or HFmrEF. 3 The statement relates to the consistent relative risk reduction for MACE in this subgroup, which owing to its high baseline risk, has a large absolute benefit.