Abstract 17975: Anemia in Heart Failure With Preserved Ejection Fraction: Insights From the TOPCAT trial

Abstract

Introduction: Anemia predicts higher rates of mortality and HF hospitalizations in patients with heart failure (HF). We sought to determine the factors associated with anemia in TOPCAT, a large randomized trial that tested the effects of spironolactone in patients with HF and preserved EF (HFpEF). Methods: Amongst the 3445 patients enrolled in TOPCAT, 3422 had available baseline hemoblobin. All significant factors assessed in baseline characteristic comparisons were put in a saturated multivariable logistic regression model along with randomized treatment assignment. The stepwise elimination method was used to obtain a parsimonious model identifying factors associated with anemia. Results: The overall prevalence of anemia (hemoglobin, Hgb < 12g/dL in women and < 13g/dL in men) was 28.5% (974 patients), with higher prevalence in patients enrolled in the Americas (41%) than in Russia/Georgia (15.4%). Previous hospitalization for HF, randomization in the Americas, older age, insulin-treated diabetes, orthopnea, peripheral edema, lower eGFR, lower diastolic BP, lower HR, and longer QRS duration were independent correlates of anemia; whereas female gender, white race, higher BMI, known dyslipidemia, left ventricular hypertrophy, and eating meals at home were independently associated with the absence of anemia (Table). Conclusions: Anemia in HFpEF is associated with multiple markers of increased cardiovascular risk, and of more advanced HF. We identified new factors associated with the absence of anemia, such as eating most meals at home. Complex interactions may underlie the observed relationships, including medications, and causality cannot be inferred from our observations.