Anemia and Early Mortality in Patients with Decompensation of Chronic Heart Failure

Abstract

Objectives: The possible independent effect of mild-to-moderate anemia (hemoglobin value not <9 g/dl) on the short-term mortality of patients with decompensation of NYHA class III/IV chronic heart failure has not been investigated yet. Methods: A total of 725 consecutive hospitalized patients were studied. All-cause mortalities during hospitalization and by day 31 were the prespecified study end points. Results: A total of 76 (10.5%) and 133 (18.3%) patients died during hospital stay and by day 31 of follow-up, respectively. Patients in the first hemoglobin tertile were at a significantly higher risk of death than those in the second (p = 0.003 and p < 0.001 for unadjusted in-hospital and 31-day mortality, respectively) or third terile (p < 0.001 and p < 0.001, for unadjusted in-hospital and 31-day mortality, respectively). However, after adjustment for concomitant baseline comorbidities and biochemical parameters, there was no significant difference in the risk of death among hemoglobin tertiles. Conclusions: Mild-to-moderate anemia seems not to contribute independently to short-term mortality in patients with decompensation of NYHA class III/IV chronic heart failure. An adverse concomitant baseline risk profile may have a key role in the induction of mild-to-moderate anemia and in the increased risk of death in these patients.

Anemia in Intensive Cardiac Care Unit patients – An underestimated problem

“…[56], the relation between Hb level and mortality 406 might be described as linear. After all, there are also some studies 407 denying an independent association occurring between anemia 408 and the risk of death both in patients with newly diagnosed HF 409 [42,57] and with decompensated HF [58]. Such results turned out 410 to be caused by the adjustment for concomitant baseline 411 comorbidities, whereas unadjusted mortality was still significantly 412 higher in patients within first Hb tertile.…”

Is Chronic Severe Anemia an Independent Predictor of Poor Outcomes?

“…In a recent issue of Cardiology, Zairis et al [6] challenge the current view that the presence of anemia is an independent predictor of mortality in heart failure patients. They provide evidence to show that anemia does not contribute independently to short-term mortality in patients admitted to the hospital for the management of acute decompensated heart failure.…”

“…Hence, there are no available studies that could be used to adequately compare the unique findings of the Zairis study [6] . Their findings are likely to be attributable to the reporting of short-term mortality in a very sick and unstable study population, more complete adjustment for important comorbidities, other unidentified confounding variables, or just a play of chance.…”