Anemia as a risk factor and therapeutic target in heart failure

Felker, G. Michael; Adams, Kirkwood F.; Gattis, Wendy A.; O’Connor, Christopher M.

doi:10.1016/j.jacc.2004.05.070

Cited by 226 publications

(165 citation statements)

References 71 publications

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“…This study shows, in accordance with several previous reports, that anemia is frequent in chronic HF patients and associated with a lower exercise capacity [1][2][3][4][5][6]. Indeed, the prevalence of anemia we observed (26%) is in agreement with what has been reported previously (between 10 and 55%) [4].…”

Section: Discussionsupporting

confidence: 93%

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Relationship of resting hemoglobin concentration to peak oxygen uptake in heart failure patients

et al. 2010

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Anemia is frequent in chronic heart failure (HF). To calculate what change in peak oxygen uptake ( _ VO 2 ) should be expected in the event of changes in hemoglobin concentration, we studied the correlation between peak _ VO 2 and hemoglobin concentration in a large HF population. We carried out retrospective analysis of all cardiopulmonary exercise tests (CPET) performed in our HF Clinic between June 2001 and March 2009 in HF patients who had a resting hemoglobin concentration measurement taken within 7 days of the CPET. We collected 967 CPETs, 704 tests were considered maximal and analyzed. We identified 181 patients (26%) as anemic. Peak _ VO 2 was lower (P < 0.001) in anemic patients (971 ± 23 ml/min) compared with nonanemic (1243 ± 18 ml/min). The slope of the _ VO 2 vs. hemoglobin ratio was 109 ml/min/g/dl at peak exercise. This correlation remained significant also when several confounding variables were analyzed by multivariate analysis. As an average, each gram of hemoglobin accounts, at peak exercise, for 109 ml/min change in _ VO 2 which is equivalent to 0.97 ml/min/kg. Therefore, in HF patients anemia treatment should increase _ VO 2 by 109 ml/min for each g/dl of hemoglobin increase. Am. J. Hematol. 85:414-417, 2010. V

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Section: Discussionsupporting

confidence: 93%

“…Anemia and reduction of exercise capacity are both frequently reported in chronic heart failure (HF) and are both associated to worsening of HF prognosis [1][2][3][4]. The two are linked to each other indirectly, having heart failure as a common underlying origin, and directly.…”

Section: Introductionmentioning

confidence: 99%

Relationship of resting hemoglobin concentration to peak oxygen uptake in heart failure patients

et al. 2010

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“…Several studies suggested that RDW may be related to the degree of infl ammation, inadequate production of erythropoietin, renal function, and nutritional status. [16][17][18] In the present study, patients with a 90-day adverse event had lower BMI, albumin, total cholesterol, triglycerides, and low-density lipoprotein cholesterol, fi ndings that are consistent with those of a previous study. 6) RDW might have clinical relevance as an easy and inexpensive surrogate marker for nutritional status associated with a poor prognosis.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Prognostic Value of Red Cell Distribution Width and NT-proBNP for Short-Term Clinical Outcomes in Acute Heart Failure Patients

Jia

Chen

et al. 2014

Int. Heart J.

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SummaryComparison of the prognostic value of red cell distribution width (RDW) and N-terminal pro B-type natriuretic peptide (NT-proBNP) for short-term clinical outcomes in acute heart failure (AHF) patients has not been fully investigated.A total of 128 patients with AHF were enrolled and followed for 3 months. Primary endpoints were cardiovascular (CV) events, defi ned as cardiac death and/or readmission for HF. Baseline RDW and NT-proBNP were measured at admission.The 30-day and 90-day CV event rates were 16.4% and 35.9%, respectively. NT-proBNP was higher in people with cardiovascular events at both time points, while RDW was signifi cantly higher only at the 90-day time point. The area under the ROC curve of RDW (area under the ROC curve = 0.695) for the prediction of CV events was higher than that of NT-proBNP (area under the ROC curve = 0.610) at the 90-day time point, but lower at the 30-day time point. Cox hazard analysis revealed RDW and NT-proBNP were independent predictive factors of a 90-day CV event (RDW, hazard ratio, 4.610, 95% confi dence interval 1.935-10.981, P = 0.001; NT-proBNP, hazard ratio, 3.661, 95% confi dence interval 1.125-11.907, P = 0.031). Kaplan-Meier survival analysis revealed that patients with an RDW level > 14.5% and NT-proBNP > 1471.5 pg/mL were at highest risk for a CV event (P < 0.001).RDW and NT-proBNP are strong independent predictors of 90-day cardiovascular events in patients hospitalized with AHF. RDW can add prognostic value to NT-proBNP for predicting early cardiovascular events. (Int Heart J 2014; 55: 58-64) Key words: Marker, Prognosis A cute heart failure (AHF) has been defi ned as new-onset or gradual or rapidly worsening heart failure signs and symptoms requiring urgent therapy. 1) It is the leading cause of hospitalization in adults over 65 years.2) AHF may result from new onset of ventricular dysfunction or, more typically, exacerbation of chronic heart failure symptoms. 3)Recognizing such higher risk patients, however, may be challenging. Although numerous parameters indicate the prognosis of heart failure, most are costly to evaluate and are assessed only in research.4) Red cell distribution width (RDW) is a measure of the variability in size of circulating erythrocytes. 5)This parameter is a widely investigated and routine laboratory value reported as a component of complete blood count.A previous study has shown RDW can be a significant independent predictor of all-cause mortality and hospital readmission for patients with chronic heart failure (CHF).6) It was also found to be an independent and addictive predictor of early mortality in patients with acute dyspnea. 7) Higher levels of RDW correlate to poorer survival in stroke, 8) myocardial infarction 9) and pulmonary hypertension. 10) However, little is known about the prognostic value of RDW in the short-term outcome in acute heart failure. Accordingly, in order to determine the prognostic utility of RDW in short-term adverse outcome in patients with AHF, we conducted a prospective study to compare RDW ...

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“…Consistent with our finding, several studies have also shown that low hemoglobin levels were strongly associated with higher risk of mortality in HD patients (25,26). Evidence shows that maintaining the hemoglobin level of HD patients at the normal range, is associated with increase in quality of life (27), improvement of cardiac and brain function (28,29) and decrease in hospitalization and cost of treatment (30). Our study confirmed the previous findings that, low serum albumin is related with severe survival (14,31,32).…”

Section: Discussionsupporting

confidence: 89%

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

Khazaei¹,

Yaseri²,

Sheikh³

et al. 2017

J Nephropathol

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Background: Hemodialysis (HD) represents the main way of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in Iran. Few studies have investigated the survival of HD patients in Iran.Objectives: This study conducted to reach better understanding predictors of survival for HD patients. Patients and Methods: This is a retrospective cohort study conducted in 1142 HD patients in Hamadan province during 11 years from 2007 to 2017. The checklist used to gather information was comprised of patient's demographic and clinical information. The analysis was carried out using Laplace regression and Cox regression model. Results:The most prevalent causes of ESRD were reported to be high blood pressure (BP) (28.9%) and diabetes (24.34%). The probability of survival at the end of 1st, 5th, and 10th year was 0.81, 0.4 and 0.13, respectively. Results of multivariate Cox regression showed that being rural dweller, low albumin, ferritin and hemoglobin level and having positive CRP at diagnosis have a negative significant impact on survival of HD patients (P < 0.05). Conclusions: Being rural dweller, low albumin and hemoglobin level and having positive CRP at diagnosis amongst other factors were possible factors affecting the survival of HD patients in this study. Considering the low survival probability of these patients, efforts should be made to real-time diagnosis of the cause of renal diseases.

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Anemia as a risk factor and therapeutic target in heart failure

Cited by 226 publications

References 71 publications

Relationship of resting hemoglobin concentration to peak oxygen uptake in heart failure patients

Relationship of resting hemoglobin concentration to peak oxygen uptake in heart failure patients

Comparison of Prognostic Value of Red Cell Distribution Width and NT-proBNP for Short-Term Clinical Outcomes in Acute Heart Failure Patients

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

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