Prevalence and prognostic implication of anemia in decompensated chronic heart failure setting

Abstract

Background: Several studies have demonstrated an association between anemia and prognosis in chronic heart failure (CHF). The role of anemia as an independent predictor of adverse outcomes needs to be confirmed in order to determine what treatment strategies, if any, are appropriate to treat anemia in this population. We examined the incidence, associated variable and short- and long-term prognosis in patients with decompensated heart failure and anemia. Methods: Between december/97 and March/00, three hundred and thirty patients were admitted because of decompensated HF. Anemia was defined by the presence of hematocrit less than 37% in women and less than 39% in men. Results: Anemia was diagnosed in 91 patients (29.1%), 24% in women vs. 32% in men (p = ns). Mean age in those with anemia (Group 1) was 62.9±14 compared with 65.5±15 in patients without anemia (Group 2)(p = ns). The following characteristics were different between Group 1 and Group 2: hypertension 33% vs 21% (p = 0.034) and chronic renal insufficiency (56 vs 27%, p = 0.002). In patients with and without anemia, NYHA functional class (2.24 vs. 2.33, p = ns) and ischemic etiology were similar (32% vs. 27%p = ns), and the prevalence of sinus rhythm was higher in subjects with anemia (34% vs 22%, p = 0.028). In groups 1 and 2, mean ejection fraction was 42.4±18 and 37.6±17% (p = 0.031), creatinine level was 1.8±1.6 vs. 1.3±0.4 mg/dL (p<0.001), and serum sodium level was 138±4.3 vs. 139.8±5.4 mEq/L (p = 0.03). Logistic regression analysis identified peripheral hypoperfusion (p<0.001,OR = 3.85) and natremia (p = 0.01,OR = 0.93) as independently associated with anemia. During hospitalization, the incidence of refractory heart failure was 8.8% in group 1 and 3.2% in group 2 (p = 0.043), and mortality rate was 2.9% vs 1% (p = ns), respectively. Twenty-four months cumulative survival was 40% in group 1 and 80% in group 2 (log rank test p = 0.041). Conclusion: Anemia was a frequent co-morbidity that afflicted one third of patients with decompensated heart failure, and it was related with other markers of disease severity. Short- as well as long-term prognosis were poor in subjects with anemia. Beside ongoing clinical trials researching the role of therapies for anemia in the treatment of patients with chronic heart failure, the effect of that therapies in decompensation setting should be evaluated