The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure
Authors:
R. Miklík 1; M. Felšöci 1; J. Pařenica 1; D. Tomčíková 2; J. Jarkovský 2; J. Špinar 1
Authors‘ workplace:
Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, CSc., FESC
1; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D.
2
Published in:
Vnitř Lék 2010; 56(5): 382-391
Category:
Original Contributions
Overview
Aim of study:
To evaluate the influence of entry hemoglobin level on the hospitalization mortality of the patients admitted with AHF caused by 4 major etiologies – acute coronary syndrome with ST elevation (STEMI, n = 325) and without ST elevation (nonSTEMI, n = 210), decompensated chronic ischaemic heart disease (IHD, n = 206) and dilated cardiomyopathy (CMP, n = 88).
Results:
We analyzed 1,253 consecutive 1st‑ time hospitalizations of AHF patients of whom 1,212 had their entry hemoglobin known. Out of these, 829 subjects were of STEMI (1), nonSTEMI (2), IHD (3) and CMP (4) etiology and were included in further analyses. We devided these patients into subgroups according to hemoglobin levels: I – no anemia, II – minor and III – severe anemia. The hospitalization mortality in subgroups (I– II– III) of each etiology was 16.9– 24.5– 35.3% (1); 12.4– 9.8– 35.7% (2); 9.0– 9.7– 18.2% (3); 1.5– 21.4– 33.3% (4); all etiologies together 12.4– 15.0– 28.8%, total rate 14.1%. Univariate analysis (χ2) showed significant differencies in hospitalization mortality depending on etiology and hemoglobin level but not type of failure (de novo/ decompensation). Other parametres (comorbidities, laboratory and hemodynamic values, medication at entry) had a very variable impact on mortality throughout etiologies and hemoglobin subgroups.
Conclusion:
The presence of anemia increases hospitalization mortality of patients with acute heart failure. The relation between hemoglobin level and mortality seems to be linear, we did not observe „U shape“ type of relation. It is necessary to distinguish etiologies of AHF as well as consider effects of laboratory and anamnestic variables when interpreting the results.
Key words:
prevalence – anemia – haemoglobin – acute heart failure – hospitalization mortality
Sources
1. Kawashiro N, Kasanuki H, Ogawa H et al. Clinical characteristics and outcome of hospitalized patients with congestive heart failure – results of the HIJC‑ HF registry. Circ J 2008; 72: 2015– 2020.
2. Perna ER, Barbagelata A, Grinfeld L et al. Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade. Am Heart J 2006; 151: 84– 91.
3. Adams KF Jr, Fonarow GC, Emerman CL et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209– 216.
4. Špinar J, Aschermann M, Al‑ Hiti H et al. Acute heart failure databases in specialist departments of cardiology (AHEAD registry). Cor Vasa 2008; 50: 12– 21.
5. Siirilä‑ Waris K, Lassus J, Melin J et al. Characteristics, outcomes, and predictors of 1‑year mortality in patients hospitalized for acute heart failure. Eur Heart J 2006; 27: 3011– 3017.
6. Zannad F, Mebazaa A, Juillière Y et al. Clinical profile, contemporary management and one‑year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006; 8: 697– 705.
7. Cleland JG, Swedberg K, Follath F et al. The EuroHeart Failure survey programme – A survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. Eur Heart J 2003; 24: 442– 463.
8. Nieminen MS, Brutsaert D, Dickstein K et al. EuroHeart Failure Survey II (EHFS II): A survey on hospitalized acute heart failure patients: Description of population. Eur Heart J 2006; 27: 2725– 2736.
9. Follath F, Delgado JF, Mebazaa A et al. Classifying patients with acute heart failure: Presentation, treatment and outcome. A ten country survey of acute heart failure management (ALARM‑ HF). Eur J Heart Fail Suppl 2008; 7: 64.
10. Miklík R, Pařenica J, Felšoci M et al. Levosimendan v léčbě akutního srdečního selhání – zkušenosti z kardiologické kliniky. Cor Vasa 2009; 51: 507– 512.
11. Fonarow GC, Adams KF Jr, Abraham WT et al. ADHERE Scientific Advisory Committee SGaI. Risk Stratification for in‑hospital mortality in acutely cecompensated heart failure: classification and regression rree analysis. JAMA 2005; 293: 572– 580.
12. Gagnon DR, Zhang TJ, Brand FN et al. Hematocrit and the risk of cardiovascular disease – The Framingham study: a 34‑year follow‑up. Am Heart J 1994; 127: 674– 682.
13. Silverberg DS, Wexler D, Blum M et al. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000; 35: 1737– 1744.
14. Felker GM, Gattis WA, Leimberger JD et al. Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure. Am J Cardiol 2003; 92: 625– 628.
15. Nordyke RJ, Kim JJ, Goldberg GA et al. Impact of anemia on hospitalization time, charges, and mortality in patients with heart failure. Value Health 2004; 7: 464– 471.
16. Tang YD, Katz SD. The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes. Heart Fail Rev 2008; 13: 387– 392.
17. World Health Organization. Nutritional anaemias: report of a WHO Scienific Group. Geneva: World Health Organization 1968.
18. IV. NKF‑ K/ DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis 2001; 37 (Suppl 1): S182– S235.
19. Maggioni AP, Opasich C, Anand I et al. Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail 2005; 11: 91– 98.
20. Androne AS, Katz SD, Lund L et al. Hemodilution is common in patients with advanced heart failure. Circulation 2003; 107: 226– 229.
21. Formiga F, Chivite D, Castañer O et al. Anemia in new‑onset congestive heart failure inpatients admitted for acute decompensation. Eur J Intern Med 2006; 17: 179– 184.
22. Dunlay SM, Weston SA, Redfield MM at al. Anemia and heart failure: a community study. Am J Med 2008; 121: 726– 732.
23. Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: Insights from a cohort of 12 065 patients with new‑onset heart failure. Circulation 2003; 107: 223– 225.
24. Kosiborod M, Curtis JP, Wang Y et al. Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med 2005; 165: 2237– 2244.
25. Kosiborod M, Smith GL, Radford MJ et al. The prognostic importance of anemia in patients with heart failure. Am J Med 2003; 114: 112– 119.
26. Nilsson‑ Ehle H, Jagenburg R, Landahl S et al. Blood haemoglobin declines in the elderly: Implications for reference intervals from age 70 to 88. Eur J Haematol 2000; 65: 297– 305.
27. Dickstein K, Cohen‑ Solal A, Filippatos Get al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008; 29: 3069.
28. Špinar J, Špinarová L, Vítovec J. The diagnosis, epidemiology, and prognosis of acute heart failure. Cor Vasa 2008; 50: 171– 175.
29. Silverberg DS, Wexler D, Blum M et al. The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization. Clin Nephrol 2002; 58 (Suppl 1): S37– S45.
30. Grune T, Sommerburg O, Siems WG. Oxidative stress in anemia. Clin Nephrol 2000; 53 (Suppl 1): S18– S22.
31. Siems WG, Sommerburg O, Grune T. Erythrocyte free radical and energy metabolism. Clin Nephrol 2000; 53 (Suppl 1): S9– S17.
32. Anand IS, Chandrashekhar Y, Wander GS et al. Endothellium‑ derived relaxing factor is important in mediating the high output state in chronic severe anemia. J Am Coll Cardiol 1995; 25: 1402– 1407.
33. Opasich C, Cazzola M, Scelsi L et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 2005; 26: 2232– 2237.
34. Volpe M, Tritto C, Testa U et al. Blood levels of erythropoietin in congestive heart failure and correlation with clinical, hemodynamic, and hormonal profiles. Am J Cardiol 1994; 74: 468– 473.
35. Cromie N, Lee C, Struthers AD. Anaemia in chronic heart failure: What is its frequency in the UK and its underlying causes? Heart 2002; 87: 377– 378.
36. Nanas JN, Matsouka C, Karageorgo-poulos D et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006; 48: 2485– 2489.
37. Anand IS, Kuskowski MA, Rector TS et al. Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: Results from Val‑ HeFT. Circulation 2005; 112: 1121– 1127.
38. Ishani A, Weinhandl E, Zhao Z et al. Angiotensin‑converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2005; 45: 391– 399.
39. Komajda M, Anker SD, Charlesworth A et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006; 27: 1440– 1446.
40. Caramelo C, Just S, Gil P. Anemia in heart failure: pathophysiology, pathogenesis, treatment, and incognitae. Rev Esp Cardiol 2007; 60: 848– 860.
41. Sharma R, Francis DP, Pitt B et al. Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J 2004; 25: 1021– 1028.
42. Tang WH, Tong W, Jain A et al. Evaluation and long‑term prognosis of new‑onset, transient, and persistent anemia in ambulatory patients with chronic heart failure. J Am Coll Cardiol 2008; 51: 569– 576.
43. McClellan WM, Flanders WD, Langston RD et al. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population‑based study. J Am Soc Nephrol 2002; 13: 1928– 1936.
44. Ceresa M, Capomolla S, Pinna G et al. Anemia in chronic heart failure patients: Comparison between invasive and non-invasive prognostic markers. Monaldi Archives for Chest Disease – Cardiac Series 2005; 64: 124–133.
45. Baggish AL, van Kimmenade R, Bayes-Genis A et al. 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 2007; 381: 145–150.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2010 Issue 5
Most read in this issue
- Familial hypercalcemia and hypophosphatemia: importance in differential diagnosis of disorders in calcium‑ phosphate metabolism
- A review of the effects of prolactin hormone and cytokine on the development and pathogenesis of autoimmune diseases
- Polycystic ovary syndrome and autoimmune diseases
- ILCOR recommendation on signing of automated external defibrillators (AEDs)