The prognostic impact of cardio-renal anaemia syndrome in Japanese acute decompensated heart failure patients stratified by left ventricular ejection fraction

Abstract

Abstract Background Cardio-renal anaemia syndrome (CRAS) has been reported to be an important prognostic factor for events in heart failure (HF) patients. Previous reports have shown that it has relatively little prognostic impact in patients with preserved left ventricular ejection fraction (LVEF), which remains controversial. We therefore investigated the prognostic impact of CRAS in Japanese acute decompensated heart failure (ADHF) patients according to LVEF. Methods We combined two registry studies of ADHF patients in Japan and examined HF events and their associated factors over a 2-year observation period. The prognostic impact of CRAS was also analysed by LVEF. The primary endpoint was defined as all-cause mortality or HF hospitalisation. Renal dysfunction was defined as eGFR <60 mL/min/1.73 m2 and anaemia as haemoglobin <13 g/dl in men and <12g/dl in women. CRAS was defined as the presence of both renal dysfunction and anaemia. Three groups were also created by LVEF (>50%, 40-49% and <40%) and analysed separately. Results A total of 2142 patients were enrolled. Mean age was 78.7 years and 49% of the patients was male. Previous coronary artery disease and atrial fibrillation were present in 31% and 44% of the patients, respectively. Medications included beta-blockers in 61% and renin-angiotensin system inhibitors in 53% of the patients. Renal dysfunction was present in 1676 (74%) and anaemia was seen in 1523 (67%) patients. CRAS was present in 1190 (53%) patients. During the mean follow-up period of 623±244 days, the primary endpoint was observed in 1015 patients, with 563 deaths and 737 HF hospitalisations. Multivariate analysis in a Cox proportional hazards model showed that CRAS was an independent prognostic factor in all patients (hazard ratio [HR]1.488;95% confidence interval [CI] 1.292-1.715, p<0.001). Multivariate analysis was also performed in three groups of patients with LVEF >50%, 40-49% and <40%. As with all patients, CRAS was an independent predictor of the primary endpoint in the three groups. (LVEF >50% [1273 patients]: HR1.313[95%CI 1.089-1.583], p = 0.004; LVEF 40-49% [381 patients]:HR,1.907[95%CI 1.323-2.750], p<0.001; LVEF <40% [651 patients]:HR: 1.446[95%CI 1.117-1.872]; p = 0.005) Conclusion In the present registry study of Japanese patients with ADHF, CRAS was a important prognostic factor. The results also confirmed a similar trend in patients with any LVEF.