Comparison of the effect of anemia on in-hospital mortality in patients with versus without preserved left ventricular ejection fraction.

Patients with symptomatic heart failure (HF) frequently have preserved left ventricular (LV) ejection fractions (LVEFs). Although anemia is a common finding in this patient population, its prognostic role has not been well studied. This study's aim was to assess if the LVEF interferes in the association between anemia and in-hospital mortality in patients with severe HF. Consecutive patients admitted to an intensive care unit with decompensated chronic HF were prospectively enrolled. The diagnosis of HF was based on clinical criteria. Patients with LVEFs > or =45% (on echocardiography) were diagnosed as having preserved LVEFs. Multivariate analysis was performed to test the independent association between anemia and in-hospital mortality and to evaluate an interaction between anemia and systolic function. In all, 303 patients were recruited (mean age 69 +/- 13 years; 45.5% women). Preserved LVEFs were present in 34% of the population. The prevalence of anemia in this group was 58%, compared with 43% in the group with systolic dysfunction (p = 0.01). Dilated left ventricles, left bundle branch blocks, and valvular dysfunction were significantly more frequent in patients with systolic heart failure. In-hospital mortality was similar in the groups with preserved LVEFs and systolic dysfunction (p = 0.71). On multivariate analysis, anemia was independently associated with in-hospital mortality (odds ratio 2.7, 95% confidence interval 1.43 to 5.04, p = 0.002). There was no interaction between anemia and systolic function (p = 0.08 for interaction). In conclusion, anemia was an independent predictor of in-hospital mortality in symptomatic patients with severe HF, regardless of whether the patients had preserved or impaired LV systolic function.