Lee TC, et al. - Researchers used data from the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction Trial (WARCEF) to assess the link between time in therapeutic range (TTR) and heart failure (HF) severity. Their goal was to assess the potential role of HF severity in the quality of warfarin control among patients with HF with reduced ejection fraction. They found that factors that were independently related to the suboptimal quality of warfarin anticoagulation control included New York Heart Association (NYHA) class III/IV, poor health-related quality of life and a higher rate of HF hospitalization, as observed in HF patients with systolic dysfunction. Based on these findings, new approaches to prevent thromboembolism in this patient population, such as direct oral anticoagulants, need to be evaluated.