Abstract MP032: Anemia is Associated With Increased Risk of Mortality in Heart Failure With Preserved Ejection Fraction in the US Veteran Population

Abstract

Background: Anemia is increasingly being identified as a poor prognostic factor in patients with heart failure with reduced ejection fraction. However, few studies, and with small sample sizes, have examined the role of anemia in patients with heart failure with preserved ejection fraction (HFpEF). Thus, the purpose of our study is to examine whether anemia is associated with mortality in a large national cohort of patients with HFpEF. Methods: We identified subjects with HFpEF using a validated algorithm in the national Veterans Affairs patient database from 2002 to 2012. The criteria for HFpEF included: all recorded ejection fractions > 50% and symptoms, signs and treatment for heart failure. Anemia was identified using the International Classification of Diseases (ICD-9) code at the index time of HFpEF diagnosis. All-cause mortality was confirmed from medical death records and Center for Medicare Services data. Using a multivariable Cox proportional hazards model, we examined the association of anemia at the time of HFpEF diagnosis with all-cause mortality. Results: In total, 29,022 HFpEF patients met criteria for HFpEF. Mean age of the participants was 71±12 years; 96% were men, 84% were white, 35% had anemia, 88% had hypertension, 65% had hyperlipidemia and 42% had coronary artery disease at baseline. After a median follow-up of 3.6 years (IQR: 1.7-6.4), 17,269 deaths occurred. After adjusting for age, sex, race, body mass index, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, chronic obstructive pulmonary disease, diabetes mellitus, serum sodium, renal function, heart rate and ejection fraction, patients with anemia had higher mortality (HR 1.52, 95% CI 1.47-1.57, p < 0.0001) as compared to those without anemia. Conclusion: Our study suggests that prevalent anemia is associated with an increased risk of all-cause mortality among US veterans with HFpEF. Further studies may shed light on its role as a prognosticator and potential therapeutic target in this population.