Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function

Abstract

Objective: To investigate the prevalence of anaemia and its influence on mortality among hospitalised patients with congestive heart failure (CHF) with preserved left ventricular systolic function (LVSF). Method and results: 210 patients with preserved LVSF admitted to the cardiology department of a tertiary hospital for CHF between 1 January 2000 and 31 December 2002 were analysed. Anaemic patients, who constituted 46% of the whole group, were older (75 v 72 years, p = 0.036); were in hospital longer (mean (SD) 13 v 11 days, p = 0.007); had a higher prevalence of ischaemic heart disease (54% v 35%, p = 0.009), left bundle branch block (12% v 4%, p = 0.018), and kidney failure (56% v 34%, p = 0.003); and had faster erythrocyte sedimentation rates (mean (SD) 50 v 26 mm in the first hour, p , 0.001), a tendency to lower serum cholesterol concentration (mean (SD) 4.65 v 5.22 mmol/l, p = 0.073), and smaller body mass index (mean (SD) 27 v 29 kg/m 2 , p = 0.126) than their nonanaemic counterparts. Kaplan-Meier analysis showed the anaemic group to have significantly poorer survival (p = 0.0001), with a one year survival rate of 72.2% versus 90.5% in the non-anaemic group. Multivariate analysis showed anaemia to be the most powerful independent predictor of mortality, increasing the risk of death by a factor of 2.7 (p = 0.007). Conclusion: Anaemia is a very prevalent condition in hospitalised patients with CHF with preserved LVSF and is independently associated with higher mortality. Appropriately designed randomised studies are needed to determine whether the prevention or treatment of anaemia can improve survival of these patients.

The Impact of Anemia on the Prognosis of Chronic Heart Failure: A Meta‐Analysis and Systemic Review

“…3,6,7,[9][10][11][12]14,16,19,20 The present study did not find significant differences between the anemia and nonanemia patients in the use of the b-blockers, ACE inhibitors, diuretics, digoxin, statins, or aspirin.…”

“…1,3 Lower mean baseline Hb concentrations significantly correlated with greater CHF severity as assessed by NYHA classification. [1][2][3]7,8,10,11,14,16 In multivariate analysis, anemia remained a significant, independent predictor of death or hospitalization for heart failure, with both outcomes being significantly higher in all NYHA classes. 4,13,16 Anemia was an independent predictor of in-hospital mortality in symptomatic patients with heart failure, regardless of whether the patients had preserved or reduced left ventricular ejection fraction.…”

“…The majority of these studies suggested that all-cause mortality or hospitalization rates in anemia patients were higher than in nonanemia patients and anemia was an independent predictor of both mortality and hospitalization. [1][2][3][4][5][6][7][8][10][11][12] Some studies even suggested that baseline Hb concentrations were an independent risk factor for mortality and low Hb was a marker of adverse outcome in CHF.…”

“…[1][2][3]5,6,8,[10][11][12]16 Anemic patients also had more severe functional impairment of the heart and were more likely to have lower systolic blood pressure. 1,3 Lower mean baseline Hb concentrations significantly correlated with greater CHF severity as assessed by NYHA classification.…”

“…[1][2][3][4][5][6][7][8] Some other studies, however, did not find anemia to have a significant impact on the prognosis of CHF, and reduced hemoglobin (Hb) levels are not independently associated with shorter survival. [9][10][11][12][13] Moreover, whether changes in Hb over time are also related to the risk of morbid events or mortality is not clear. [14][15][16] Given the inconsistencies in the published studies, we performed a meta-analysis and systemic review of the results from the recent publications.…”