Impact of Cardiorenal Anaemia Syndrome on Clinical Features in Elderly Outpatients with Chronic Heart Failure: A Japanese Community Hospital Experience

Abstract

Background: Cardiorenal anaemia syndrome (CRAS) has been reported to be associated with all-cause mortality and cardiovascular events in outpatients with heart failure (HF). Objective: To evaluate the clinical situation of CRAS including NYHA class and care status in elderly outpatients with HF. Methods: A total of 41 elderly (>65 years) outpatients with HF attending our hospital were analysed retrospectively and cross-sectionally. Clinical variables included lifestyle diseases, atrial fibrillation, valvular heart disease, HFpEF, chronic kidney disease (CKD), cardiac function (LVEF, E/e’, LADI, BNP), anaemia (Hb, Fe/TIBC (%), ferritin), medications (diuretics, MRA, ACEI/ARB, β-blockers, SGLT2i, ARNI, tolvaptan), NYHA class (I/II/III/IV). The nursing variables analysed were Japanese nursing certification class, which assesses active daily living (ADL), instrumental ADL, cognitive function, mental function, physical function, communication, and need for support/care (from least to most intensive, independence 0/support(S)1/S2/care(C)1/C2/C3/C4/C5) and frailty. Subjects were divided into two groups (CRAS+group and CRAS−group) according to the presence of CRAS, defined as HF associated with CKD (eGFR < 60 mL/min/1.73 m2) and anaemia (Hb < 13 g/dL, men and Hb < 12 g/dL, women). All variables were compared between the two groups. Results: Mean age was 83.7 ± 7.1 years (67∼100). Female gender was 63.4% (26/41). The incidence of HFpEF was 33/41 (80.5%). The incidence of CRAS was 53.7% (22/41). The incidence of lifestyle diseases was not different between the two groups. Cardiac function was not significantly different between the two groups (CRAS+ vs. CRAS−): LVEF (59.1 ± 8.3 vs. 61.3 ± 7.2); E/e (15.1 ± 5.8 vs. 15.0 ± 7.0); LAVI (50.6 ± 16.6 vs. 54.3 ± 30.9); BNP (347.0 ± 234.4 vs. 291.3 ± 197.0). Hb was significantly lower in the CRAS+ group than in the CRAS group (10.4 ± 1.4 vs. 13.4 ± 1.7, P < 0.0001). Fe/TIBC and ferritin were not significantly different between the two groups. Regarding medications, tolvaptan tended to be used more frequently in the CRAS+ group than in the CRSA− group (4/22 vs. 0/18, P = 0.111). The other drugs were used with similar frequency. Meanwhile, the NYHA class tended to be higher in the CRAS+ group than in the CRAS− group: NYHA (8/9/5/0 vs. 8/11/0/0, P = 0.082). Nursing class showed more intensive care in the CRAS+ group than in the CRAS−group (4/3/3/2/4/1/3/2 vs. 11/0/6/1/0/1/0/0, P = 0.021). Conclusions: The association of CRAS with HF was associated with more intensive support/care status but not with cardiac function/BNP and other factors. Prevention and active treatment of CRAS may improve the independence of elderly outpatients with HF.