Abstract
Background: Previous studies have shown low hemoglobin (Hb) to have an adverse effect on survival in congestive heart failure (CHF) patients with reduced left ventricular (LV) ejection fraction (EF). But its effect on survival in patients with CHF and normal EF is not known. Methods: Detailed chart reviews were performed by medical residents on 2246 patients (48% with normal EF, EF ≥50%) with a discharge diagnosis of CHF in a large tertiary care hospital between 1990-1999. The CHF diagnosis was confirmed using the Framingham criteria. Mortality data was obtained from the National Death Index. Survival analysis was performed using Kaplan-Meier and Cox regression models. Results: Mean age was 70±13, 47% males, EF 64±9% in patients with normal EF. Mean age was 64±9, 63% were males, EF was 28±11 in patients with reduced EF. Mean duration of follow up was 1069 days. By Kaplan-Mieir analysis, low Hb (<12 gm/dl) was associated with a lower 5 year survival in CHF patients with both normal (38 vs 50%, p=0.0008) and reduced (35 vs 48%, p=0.0009) EF. Low Hb was an independent predictor of mortality after adjusting for age, gender, renal dysfunction, diabetes mellitus, hypertension and ejection fraction in both groups of patients. Conclusion: 1) Low Hb has an independent adverse effect on prognosis in CHF patients with both normal and reduced EF. 2) Its pathogenesis and a potential role for erythropoietin therapy need further investigations in CHF patients with normal EF.
Published Version
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