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Prevalence and prognostic role of anaemia in patients with acute heart failure and preserved or depressed ventricular function

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Abstract

Observations available for patients with acute heart failure (HF) show conflicting results, and the prognostic role of anaemia ascertained on hospital admission is not well defined. We investigated the database of the Italian Survey on Acute Heart Failure (IS-AHF) to analyze prevalence, factors associated with and the prognostic role of anaemia (defined as haemoglobin < 12 g/dl) in patients hospitalized for acute HF with either depressed or preserved (>40%) ejection fraction (EF). The median haemoglobin level of the 2,318 patients considered in this analysis was 13 g/dl (inter-quartile range 11.5–14.3). The prevalence of anaemia was 31%. Patients who had anaemia were older, more frequently female gender, hospitalized for a chronic destabilized HF, had higher prevalence of preserved EF, hyponatremia, elevated troponin and other comorbidities (including diabetes, peripheral artery disease, chronic renal failure) than those who did not have anaemia. During the hospital stay, they were treated with higher doses of diuretics, and more frequently required mechanical ventilation and ultrafiltration, and less frequently received ACEi/ARB, aldosterone blockers and beta-blockers at hospital discharge. In-hospital mortality was 12.1 and 5.3% in patients with and without anaemia, respectively (p < 0.0001). In the multivariable analysis, anaemia was a significant independent predictor of in-hospital mortality apart from age, low systolic blood pressure, impaired renal function, elevated troponin assay, the non use of beta-blocker and the requirement of inotropic drug. In conclusion, anaemia diagnosed at hospital admission for acute HF is a frequent comorbidity with meaningful implications on the clinical management and prognosis both in patients with reduced and preserved EF.

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Reference

  1. Jessup M, Brozena S (2003) Heart failure. N Engl J Med 348:2007–2018

    Article  PubMed  Google Scholar 

  2. Fang J, Mensah GA, Croft JB, Keenan NL (2008) Heart failure-related hospitalization in the US, 1979 to 2004. J Am Coll Cardiol 52:428–434

    Article  PubMed  Google Scholar 

  3. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW et al (2004) Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam Study. Eur Heart J 25:1614–1619

    Article  PubMed  Google Scholar 

  4. Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R et al (2003) Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol 42:1226–1233

    Article  PubMed  Google Scholar 

  5. Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ et al (2008) Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 52:818–827

    Article  PubMed  Google Scholar 

  6. Tang YD, Katz SD (2006) Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation 113:2454–2461

    Article  PubMed  Google Scholar 

  7. Kosiborod M, Curtis JP, Wang Y, Smith GL, Masoudi FA, Foody JM et al (2005) Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med 165:2237–2244

    Article  PubMed  Google Scholar 

  8. Young JB, Abraham WT, Albert NM, GattisStough W, Gheorghiade M, OPTIMIZE-HF Greenberg BH Investigators and Coordinators et al (2008) Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol 101:223–230

    Article  PubMed  CAS  Google Scholar 

  9. Silva RP, Barbosa PH, Kimura OS, Sobrinho CR, Sousa Neto JD, Silva FA et al (2007) Prevalance of anemia and its association with cardio-renal syndrome. Int J Cardiol 120:232–236

    Article  PubMed  Google Scholar 

  10. Tavazzi L, Maggioni AP, Lucci D, Cacciatore G, Ansalone G, Oliva F, Porcu M, Italian survey on Acute Heart Failure Investigators (2006) Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J 27:1207–1215

    Article  PubMed  Google Scholar 

  11. Van Buuren S, Oudshoorn CGM. MICE: Multivariate Imputation by Chained Equations. R package version 1.14. Available at: http://web.inter.nl.net/users/S.van.Buuren/mi/hmtl/mice.htm

  12. Barnard J, Rubin DB (1999) Small sample degrees of freedom with multiple imputation. Biometrika 86:955–984

    Article  Google Scholar 

  13. Adlbrecht C, Kommata S, Hülsmann M, Szekeres T, Bieglmayer C, Strunk G et al (2008) Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body’s red cell volume. Eur Heart J 29:2343–2350

    Article  PubMed  Google Scholar 

  14. Westenbrink BD, Visser FW, Voors AA, Smilde TD, Lipsic E, Navis G et al (2007) Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J 28:166–171

    Article  PubMed  CAS  Google Scholar 

  15. Androne AS, Katz SD, Lund L, LaManca J, Hudaihed A, Hryniewicz K et al (2003) Hemodilution is common in patients with advanced heart failure. Circulation 107:226–229

    Article  PubMed  Google Scholar 

  16. Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R et al (2005) Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 26:2232–2237

    Article  PubMed  CAS  Google Scholar 

  17. van der Meer P, Lok DJ, Januzzi JL, de la Porte PW, Lipsic E, van Wijngaarden J et al (2008) Adequacy of endogenous erythropoietin levels and mortality in anaemic heart failure patients. Eur Heart J 29:1510–1515

    Article  PubMed  Google Scholar 

  18. Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM et al (2006) Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation 113:2713–2723

    Article  PubMed  CAS  Google Scholar 

  19. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR (2006) Impact of anemia on hospitalization and mortality in older adults. Blood 107:3841–3846

    Article  PubMed  CAS  Google Scholar 

  20. Baggish AL, van Kimmenade R, Bayes-Genis A, Davis M, Lainchbury JG, Frampton C et al (2007) Hemoglobin and N-terminal pro-brain natriuretic peptide: Independent and synergistic predictors of mortality in patients with acute heart failure Results from the International Collaborative of NT-proBNP (ICON) Study. Clin Chim Acta 381:145–150

    Article  PubMed  CAS  Google Scholar 

  21. Maggioni AP, Opasich C, Anand I, Barlera S, Carbonieri E, Gonzini L, Tavazzi L, Latini R, Cohn J (2005) Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail 11:91–98

    Article  PubMed  Google Scholar 

  22. Tang WH, Tong W, Jain A, Francis GS, Harris CM, Young JB (2008) Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure. J Am Coll Cardiol 51:569–576

    Article  PubMed  Google Scholar 

  23. Komajda M, Anker SD, Charlesworth A, Okonko D, Metra M, Di Lenarda A et al (2006) The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 27:1440–1446

    Article  PubMed  Google Scholar 

  24. Astor BC, Muntner P, Levin A, Eustace JA, Coresh J (2002) Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 162:1401–1408

    Article  PubMed  Google Scholar 

  25. McFarlane SI, Chen SC, Whaley-Connell AT, Sowers JR, Vassalotti JA, Salifu MO et al, Kidney Early Evaluation Program Investigators (2008) Prevalence and associations of anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis 51(4 Suppl 2):S46–S55

    Google Scholar 

  26. Latado AL, Passos LC, Darzé ES, Lopes AA (2006) Comparison of the effect of anemia on in-hospital mortality in patients with versus without preserved left ventricular ejection fraction. Am J Cardiol 98:1631–1634

    Article  PubMed  Google Scholar 

  27. Felker GM, Shaw LK, Stough WG, O’Connor CM (2006) Anemia in patients with heart failure and preserved systolic function. Am Heart J 151:457–462

    Article  PubMed  Google Scholar 

  28. Dunlay SM, Weston SA, Redfield MM, Killian JM, Roger VL (2008) Anemia and heart failure: a community study. Am J Med 121:726–732

    Article  PubMed  Google Scholar 

  29. O’Meara E, Clayton T, McEntegart MB, McMurray JJ, Lang CC, Roger SD, CHARM Committees, Investigators et al (2006) Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation 113:986–994

    Article  PubMed  Google Scholar 

  30. Chatterjee K, Massie B (2007) Systolic and diastolic heart failure: differences and similarities. J Card Fail 13:569–576

    Article  PubMed  Google Scholar 

  31. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, ADHERE Scientific Advisory Committee and Investigators (2006) Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 47:76–84

    Article  PubMed  Google Scholar 

  32. Tarantini L, Cioffi G, Gonzini L, Oliva F, Lucci D, Di Tano G, Maggioni AP, Tavazzi L, on behalf of the Italian Acute Heart Failure Survey (2010) Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure. J Cardiovasc Med 11:234–243

    Article  Google Scholar 

  33. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J, ADHERE Scientific Advisory Committee and Investigators (2007) High prevalence of renal dysfunction and its impact on outcome in 118, 465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 13:422–430

    Article  PubMed  Google Scholar 

  34. Jie KE, Verhaar MC, Cramer MJ, van der Putten K, Gaillard CA, Doevendans PA et al (2006) Erythropoietin and the cardiorenal syndrome: cellular mechanisms on the cardiorenal connectors. Am J Physiol Renal Physiol 291:F932–F944

    Article  PubMed  CAS  Google Scholar 

  35. Kazory A, Ross EA (2009) Anemia: the point of convergence or divergence for kidney disease and heart failure? J Am Coll Cardiol 53:639–647

    Article  PubMed  Google Scholar 

  36. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539

    Article  PubMed  Google Scholar 

  37. Herzog CA, Muster HA, Li S, Collins AJ (2004) Impact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population. J Card Fail 10:467–472

    Article  PubMed  Google Scholar 

  38. Nash K, Hafeez A, Hou S (2002) Hospital-acquired renal insufficiency. Am J Kidney Dis 39:930–936

    Article  PubMed  Google Scholar 

  39. du Cheyron D, Parienti JJ, Fekih-Hassen M, Daubin C, Charbonneau P (2005) Impact of anemia on outcome in critically ill patients with severe acute renal failure. Intensive Care Med 31:1529–1536

    Article  PubMed  Google Scholar 

  40. Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson JE (2006) Association of anemia with outcomes in men with moderate and severe chronic kidney disease. Kidney Int 69:560–564

    Article  PubMed  CAS  Google Scholar 

  41. Tehrani F, Dhesi P, Daneshvar D, Phan A, Rafique A, Siegel RJ et al (2009) Erythropoiesis stimulating agents in heart failure patients with anemia: a meta-analysis. Cardiovasc Drugs Ther 23:511–518

    Google Scholar 

  42. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H et al, the FAIR-HF Trial Investigators (2009) Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 361:2436–2448

    Google Scholar 

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Acknowledgments

The study was partially supported by an unrestricted educational grant from Abbott Italy.

Conflict on interest

None.

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Authors and Affiliations

  1. Cardiology Department, St. Martino Hospital ASL 1, Belluno, Italy

    Luigi Tarantini

  2. Cardiologia 2, Azienda Ospedaliera Niguarda Cà Granda, Milan, Italy

    Fabrizio Oliva

  3. SC di Ematologia, Azienda Ospedaliera Niguarda Cà Granda, Milan, Italy

    Silvia Cantoni

  4. Cardiology Department, Villa Bianca Hospital, Trento, Italy

    Giovanni Cioffi

  5. Cardiology Unit, Nuovo Ospedale Sant’Agostino-Estense, Modena, Italy

    Virginia Agnoletto

  6. Division of Cardiology, University of Perugia, Perugia, Italy

    Gianfranco Alunni

  7. Cardiology Unit, Ospedale Santa Maria del Prato, Feltre, Italy

    Francesca De Cian

  8. Cardiovascular Center, Azienda Servizi Sanitari N. 1 Triestina, Trieste, Italy

    Andrea Di Lenarda

  9. ANMCO Research Center, Via La Marmora 34, Florence, Italy

    Donata Lucci & Aldo Pietro Maggioni

  10. Heart Failure Clinic, Division of Cardiology/CCU Unit, San Camillo Hospital, Rome, Italy

    Giovanni Pulignano

  11. Cardiology Department, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy

    Laura Scelsi

  12. GVM Care and Research, Maria Cecilia Hospital, Ettore Sansavini Health Science Foundation, Cotignola, Italy

    Luigi Tavazzi

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  1. Luigi Tarantini
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  2. Fabrizio Oliva
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Corresponding author

Correspondence to Aldo Pietro Maggioni.

Additional information

On behalf of Italian Survey on Acute Heart Failure Investigators.

The complete list of the Italian Survey on Acute Heart Failure Investigators has been already published as Appendix of ref 10.

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Tarantini, L., Oliva, F., Cantoni, S. et al. Prevalence and prognostic role of anaemia in patients with acute heart failure and preserved or depressed ventricular function. Intern Emerg Med 8, 147–155 (2013). https://doi.org/10.1007/s11739-011-0601-z

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  • DOI: https://doi.org/10.1007/s11739-011-0601-z

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