Robert J Mentz1, Stephen J Greene1, Andrew P Ambrosy1, Muthiah Vaduganathan1, Haris P Subacius1, Karl Swedberg1, Aldo P Maggioni1, Savina Nodari1, Piotr Ponikowski1, Stefan D Anker1, Javed Butler1, Mihai Gheorghiade2. 1. From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.). 2. From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.). m-gheorghiade@northwestern.edu.
Abstract
BACKGROUND: Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. METHODS AND RESULTS: An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). CONCLUSIONS: Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
BACKGROUND:Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. METHODS AND RESULTS: An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). CONCLUSIONS: Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
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