Clinical Correlates and Consequences of Anemia in a Broad Spectrum of Patients With Heart Failure

Author:

O’Meara Eileen1,Clayton Tim1,McEntegart Margaret B.1,McMurray John J.V.1,Lang Chim C.1,Roger Simon D.1,Young James B.1,Solomon Scott D.1,Granger Christopher B.1,Östergren Jan1,Olofsson Bertil1,Michelson Eric L.1,Pocock Stuart1,Yusuf Salim1,Swedberg Karl1,Pfeffer Marc A.1

Affiliation:

1. From the Western Infirmary, Glasgow, UK (E.O., M.B.M., J.J.V.M.); Montreal Heart Institute, Montreal, Quebec, Canada (E.O.); London School of Hygiene and Tropical Medicine, London, UK (T.C., S.P.); Ninewells Hospital & Medical School, Dundee, UK (C.C.L.); Gosford Hospital, Gosford, New South Wales, Australia (S.D.R.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Brigham & Women’s Hospital, Boston, Mass (S.D.S, M.A.P.); Duke University Medical Center, Durham, NC (C.B.G.); Karolinska...

Abstract

Background— We wished to determine the prevalence of, potential mechanistic associations of, and clinical outcomes related to anemia in patients with heart failure and a broad spectrum of left ventricular ejection fraction (LVEF). Methods and Results— In multivariable analyses, we examined the associations between hemoglobin and baseline characteristics, laboratory variables, and outcomes in 2653 patients randomized in the CHARM Program in the United States and Canada. Anemia was equally common in patients with preserved (27%) and reduced (25%) LVEF but was more common in black and older patients. Anemia was associated with ethnicity, diabetes, low body mass index, higher systolic and lower diastolic blood pressure, and recent heart failure hospitalization. More than 50% of anemic patients had a glomerular filtration rate <60 mL · min −1 · 1.73 m −2 compared with <30% of nonanemic patients. Despite an inverse relationship between hemoglobin and LVEF, anemia was associated with an increased risk of death and hospitalization, a relationship observed in patients with both reduced and preserved LVEF. There were 133 versus 69 deaths and 527 versus 352 hospitalizations per 1000 patient-years of follow-up in anemic versus nonanemic patients (both P <0.001). The effect of candesartan in reducing outcomes was independent of hemoglobin. Conclusions— Anemia was common in heart failure, regardless of LVEF. Lower hemoglobin was associated with higher LVEF yet was an independent predictor of adverse mortality and morbidity outcomes. In heart failure, the causes of anemia and the associations between anemia and outcomes are probably multiple and complex.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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