Anemia In Heart Failure Patients Research Articles

Insights on prevalence and incidence of anemia and rapid up-titration of oral heart failure treatment from the STRONG-HF study.

Anemia is one of the most frequent comorbidities in patients with heart failure (HF), which potentially can interfere with the effect of guideline-recommended HF medical therapy and can be associated with the use of neurohormonal blockers. The aim of this analysis was to determine the prevalence and changes of anemia status in the STRONG-HF study, its association with clinical endpoints, and possible interaction of the presence of anemia with the efficacy and safety of high-intensity HF treatment. The design and main results of the study have been previously described. Patients were randomized within 2days prior to anticipated hospital discharge after HF worsening in a 1:1 fashion to either high-intensity care (HIC) or usual care (UC). Baseline characteristics, clinical and safety outcomes, and treatment effect of HIC vs. UC on the primary and secondary outcomes were compared in groups based on baseline anemia. In addition, dynamics of hemoglobin during the study follow-up and predictors of incident anemia at 90days were investigated. The proportion of anemia in 1077 STRONG-HF patients at enrollment was 27.2%, while at 90days, it changed to 32.1%. The primary composite outcome occurred in 18.2% of patients without baseline anemia, and 22.5% of patients with baseline anemia (unadjusted HR 1.27; 95% CI 0.90-1.80), a difference that did not reach statistical significance. However, patients with baseline anemia had significantly less improvement of EQ-VAS questionnaire values from baseline to day 90 (adjusted LS-Mean difference -2.34 (-4.37, -0.31), P = 0.02). During the study, anemia developed in 19.4 and 14.6% in HIC and UC groups, respectively. The opposite phenomenon-recovery of anemia-occurred in 27.6 and 28.8% in HIC and UC groups (P = 0.1379). The predictors of incident anemia at 90days were male sex, geographical region other than Europe, ischemic etiology, higher glucose, and elevated uric acid at baseline. The percentages of optimal doses of renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists were not different between anemic and non-anemic patients. High-intensity care strategy did not increase rate of incident anemia at 90days and reduced the rate of primary and secondary endpoints regardless of baseline hemoglobin. Hemoglobin level and status of anemia have a dynamic nature in the acute HF patients in the post-discharge period dependent on multiple factors. High-intensity HF treatment is safe and beneficial regardless of baseline hemoglobin level and presence of anemia. The improvement of quality of life is significantly lower in anemic HF patients implying specific attention to correction of this condition.

A Critical Investigation of Sick Euthyroid Syndrome in Chronic Heart Failure Patients: Addressing the Need for Accurate Thyroid Assessment.

Background The body undergoes numerous metabolic changes during severe illness or physiological stress to protect itself by lowering metabolism and reducing overall demands. This evolutionary adaptation dates back to early human development, long before the advent of ICU facilities and advanced treatments. One such protective mechanism is Sick Euthyroid Syndrome (SES), also known as Non-thyroidal Illness Syndrome (NTIS). SES commonly occurs in critically ill patients and is frequently observed in conditions such as heart failure, chronic kidney disease, and severe sepsis. This syndrome is characterized by abnormal thyroid function tests in patients with acute or chronic systemic illnesses who do not have intrinsic thyroid disease. Typically, these patients exhibit low serum levels of triiodothyronine (T3), normal or low levels of thyroxine (T4), and normal or low thyroid-stimulating hormone (TSH) levels. SES is believed to be an adaptive response to illness, aimed at reducing the body's metabolic rate and conserving energy during severe physiological stress. This original article delves into SES's prevalence and clinical impact in these settings. Materials and methods The study aims to determine the prevalence of SES in patients with long-standing heart failure, elucidate the relationship between thyroid function and heart failure severity, and assess its impact on various hematological and clinical parameters. This observational, cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, a 2011-bed hospital, over one and a half years. This study included 70 patients with chronic heart failure, aged 18 years and above, defined by a left ventricular ejection fraction of 40% or less and a Boston criteria score of 8 or more. Patients were excluded if they had a history of thyroid dysfunction, clinical sepsis, or were taking thyroid-affecting drugs. Results The study provides important insights into the prevalence and impact of SES in long-standing heart failure patients. It found that a significant 44.29% of these patients exhibited low T3 levels, highlighting the substantial occurrence of SES in this population. Additionally, the study revealed a negative correlation between N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels, Boston score, and total T3, suggesting that as indicators of heart failure severity worsen, total T3 levels may decrease further. Another key finding is the high prevalence of anemia among heart failure patients, with a notable gender disparity: 92.11% of male patients were affected compared to 50% of female patients. Conclusion The study concluded that SES is significantly prevalent among long-standing heart failure patients, further indicating that thyroid suppression increases with the severity of heart failure. Recognizing SES can guide tailored treatments, prompting intensive monitoring and optimized heart failure management.Additionally, the study found a high prevalence of anemia, particularly among male patients, highlighting the need for gender-specific considerations in managing heart failure. These findings underscore the importance of routine thyroid function assessments and regular monitoring of anemia in heart failure patients. Future research should focus on improving clinical outcomes through comprehensive management of both thyroid function and anemia in these patients.

Non-cardiac comorbidities in heart failure: an update on diagnostic and management strategies.

Managing non-cardiac comorbidities in heart failure (HF) requires a tailored approach that addresses each patient's specific conditions and needs. Regular communication and coordination among healthcare providers is crucial to providing the best possible care for these patients. Poorly controlled hypertension contributes to left ventricular remodeling and diastolic dysfunction, emphasizing the importance of optimal blood pressure control while avoiding adverse effects. Among HF patients with diabetes, SGLT2 inhibitors and mineralocorticoid receptor antagonists have shown promise in reducing HF-related morbidity and mortality. Chronic kidney disease exacerbates HF and vice versa, forming the vicious cardiorenal syndrome, so disease-modifying therapies should be maintained in HF patients with comorbid CKD, even with transient changes in kidney function. Anemia in HF patients may be multifactorial, and there is growing evidence for the benefit of intravenous iron supplementation in HF patients with iron deficiency with or without anemia. Obesity, although a risk factor for HF, paradoxically offers a better prognosis once HF is established, though developing treatment strategies may improve symptoms and cardiac performance. In HF patients with stroke and atrial fibrillation, anticoagulation therapy is recommended. Among HF patients with sleep-disordered breathing, continuous positive airway pressure may improve sleep quality. Chronic obstructive pulmonary disease often coexists with HF, and many patients can tolerate cardioselective beta-blockers. Cancer patients with comorbid HF require careful consideration of cardiotoxicity risks associated with cancer therapies. Depression is underdiagnosed in HF patients and significantly impacts prognosis. Cognitive impairment is prevalent in HF patients and impacts their self-care and overall quality of life.

Association between low selenoprotein P concentrations and anaemia in hospitalized heart failure patients.

Heart failure (HF) patients with anaemia tend to have a worse outcome, with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anaemia. Limited research exists on the association between selenium deficiency and anaemia specifically in HF patients, despite previous findings of a correlation in different populations. The BIOSTAT-CHF study demonstrated that higher selenium levels in HF patients were associated to a lower risk of anaemia and iron deficiency. This study investigates the relationship between selenoprotein P (SELENOP) concentrations, a major contributor and functional biomarker of selenium transport, and anaemia, Hb levels, and iron status in hospitalized HF patients. SELENOP was analysed in 320 hospitalized HF subjects, with complete data available for 310 subjects. The relationships between continuous SELENOP concentrations and 1) Hb concentrations, 2) anaemia (Hb<115g/L (women), <130g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increases in iron deficiency) were evaluated using multivariable logistic and linear regression models. Additionally, SELENOP concentrations in the lowest quartile were related to anaemia, haemoglobin, and iron state in multivariable logistic and linear models. The mean age of the study population was 75.0±11.6years, and 30% were women. Anaemia was present in 133 subjects (42.9%). SELENOP concentrations were positively correlated with haemoglobin concentrations (0.238; P<0.001) and negatively with TfR1 concentrations (-0.238, P<0.001). In multivariable regression models, higher SELENOP concentrations were associated with higher Hb concentrations (B=3.23; P=0.002) and lower TfR1 concentrations (B=-0.20; P<0.001). Furthermore, SELENOP deficiency was associated with lower Hb concentrations (B=-7.64: P=0.001), higher TfR1 concentrations (B=0.31; P=0.003), and higher odds of anaemia in HF patients (odds ratio 2.17; 95% confidence interval 1.23-3.82; P=0.008). In hospitalized heart failure patients, lower concentrations of SELENOP were associated with higher prevalence of anaemia.

Selenium deficiency is associated with anemia in heart failure patients - The HARVEST Study

Abstract Background Heart failure (HF) patients with anemia have worse clinical outcomes with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anemia. Previous studies have indicated a correlation between selenium deficiency and anemia in healthy elderly individuals and in pregnant women. The BIOSTAT-CHF study reported that HF patients with higher selenium levels were less likely to have anemia or iron deficiency. These studies suggest that selenium deficiency can lead to the development of anemia. However, studies regarding this association in HF patients are limited. Purpose The purpose of this study was to examine the relationship between selenium deficiency, measured by selenoprotein P (SELENOP) levels, and anemia, hemoglobin levels, and iron state in subjects with acute HF. Methods SELENOP, a well-validated plasma marker of selenium status, was measured in 320 subjects hospitalized for HF in the Swedish HeArt and bRain failure inVESTigation trial (the HARVEST study). Of these subjects, 310 had complete data on all covariates. Prior to analyses, skewed variables were ln-transformed. The relationships between continuous SELENOP levels and 1) Hb levels, 2) anemia (Hb &amp;lt; 115 g/L (women), &amp;lt; 130 g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increase in iron deficiency) were evaluated using multivariable logistic and linear regression models adjusting for age, sex and renal function (cystatin C). Additionally, selenium deficiency was defined as SELENOP levels in the lowest quartile and its association with anemia, hemoglobin, and iron state was explored in multivariable logistic and linear models. Results Anemia was present in 133 subjects (42.9%). SELENOP levels were positively correlated with hemoglobin levels (0.238; p = 2.3x10-5) and negatively associated with TfR1 levels (-0.238, p = 2.0x10-6). In multivariable linear regression models, each 1 standard deviation increase in SELENOP was linked to higher Hb levels and lower TfR1 levels (Table 1). Furthermore, selenium deficiency was associated with lower Hb levels, higher TfR1 levels, and higher odds of anemia in HF patients (Table 1). Conclusions In acute heart failure patients, lower levels of selenoprotein P were associated with lower hemoglobin levels, higher transferrin receptor 1 levels, and a higher prevalence of anemia.

Hypoxia-inducible factor prolyl hydroxylase inhibitors for anemia in heart failure patients: A protocol for systematic review and meta-analysis.

BackgroundAnemia is common in heart failure (HF) patients with chronic kidney disease (CKD) and is associated with worse outcomes. Iron supplementation improves symptoms and is associated with reduced risk of hospitalization for HF in iron-deficiency HF patients. However, iron deficiency is present in <30% of anemic HF patients. Erythropoiesis stimulating agents (ESAs) improve symptoms but are associated with increased risk of thromboembolic events in anemic HF patients with CKD. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are a new class of agents for the treatment of anemia. These agents work by stabilizing the HIF complex, thereby stimulating endogenous erythropoietin production. We hypothesized that HIF-PH inhibitors may be associated with reduced risk of cardiovascular outcomes compared with ESAs in anemic HF patients with CKD. Accordingly, we aim to perform the meta-analysis of studies on the efficacy and safety of HIF-PH inhibitors compared with ESAs in anemic HF patients with CKD.MethodsThis meta-analysis will include prospective cohort studies and randomized controlled trials on the effect of HIF-PH inhibitors compared with ESAs in anemic HF patients with CKD. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be cardiovascular death. The secondary outcomes will be all-cause death, hospitalization for HF, HF symptoms, exercise capacity, health-related quality of life, and hemoglobin levels.DiscussionThis meta-analysis will evaluate the effect of HIF-PH inhibitors in anemic HF patients with CKD, providing evidence regarding the use of HIF-PH inhibitors in these patients.Systematic review registrationINPLASY202230103.

Anemia and Heart Failure: A Narrative Review.

Anemia in heart failure patients is a relatively common finding and has been linked with an increased risk of hospital admissions, morbidities, and significant mortality making its correction a significant factor in improving the quality of life and clinical outcomes in those suffering from it. This review article has discussed the multifactorial pathophysiology, including iron deficiency, longstanding inflammation, abnormal levels of human erythropoietin (Epo), and the abnormal activation of the renin-angiotensin-aldosterone system (RAAS) being the most significant. The diagnostic guidelines as well as research-based management modalities specifically with iron supplements and erythropoietin stimulating agents have also been discussed, although research done in this area has been limited and shown conflicting results.

ANEMIA IN PATIENTS WITH HEART FAILURE AND ITS CORRELATION WITH NT-PRO BNP: A RETROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Objective: To assess the prevalence of nutritional of anemia in Heart Failure patients and its correlation with the serum levels of NT-pro BNP. Methods: This is a single-center retrospective observational study, conducted at a tertiary care hospital in south India. Patients admitted to hospital with clinical diagnosis of HF based on validated clinical criteria were included in the study. Anemia was dened as hemoglobin (Hb) &lt;13 g/dl for males and &lt;12 g/dl for females, based on World Health Organization denition. Anemia was classied based on complete Iron prole, including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT). Serum levels of Vit B12 and Folate also assayed. Plasma concentrations of NTpro-BNP levels were assessed and correlated with the above parameters. A total of 100 patients ofResults: HF (69% males and 31% females) were studied. Most of the patients were of high-functional NYHA class ( NYHA Class III 81%) and with Moderate LV systolic Dysfunction (44%). Iron Deciency (ID)anemia was present in 72% patients with 50.4% patients having absolute and 21.6% patients having functional ID. Females were having signicantly higher prevalence of ID than males (80.6% vs 68.1%; p = 0.002). The NTpro-BNP levels in patients with IDA were statistically signicant (with p&lt;0.01) when compared to patients with normal iron levels . Conclusion: This study concludes that ID is much more common in patients with Heart Failure compared to Vit B12 or Folic acid deciency. The NTpro- BNP levels are elevated to much higher values in patients of heart failure with comorbid iron deciency states. Treating ID along with the routine heart failure management may improve the Quality of Life in HF patients.

Anemia And Other Independent Predictors Of 30-day Readmissions In Heart Failure Patients: A Retrospective Study

<h3>Objectives</h3> To determine if there is an association between anemia and 30-day readmissions in patients with heart failure, and to identify other risk factors for 30-day readmissions in this group. <h3>Background</h3> : Anemia commonly occurs in patients with chronic heart failure, with a prevalence of up to 79%. It can be explained by the presence of comorbidities, chronic kidney disease, and differences in heart failure treatment. Anemia is likely associated with worse clinical outcomes in those patients because of a mismatch in oxygen supply and demand, increased resistance to erythropoietin, higher rates of left ventricular hypertrophy and fluid overload, and chronic inflammation. Findings associated with anemia in heart failure patients include symptoms, echocardiogram measurements, renal function, mortality, hospitalization rates and lengths of hospital stays. Few studies, however, have assessed the association of anemia with 30-day readmission rates in these patients. <h3>Methods</h3> : We conducted a retrospective chart review of patients with heart failure admitted to Ascension St John Hospital in Michigan from 1/1/2018 to 12/31/2019. Data were collected on demographics, comorbidities, laboratory testing during the index hospitalization, echocardiogram findings, and 30-day readmissions. Anemia was defined as hemoglobin less than 13 g/dL in males and hemoglobin less than 12 g/dL in females. Data were analyzed using Student's t-test, the χ2 test and logistic regression. <h3>Results</h3> : We reviewed 1250 patients with heart failure, 58.2% male, 52.6% non-white, mean age 68.2 ± 15.3 years. Of those patients, 24.2% (303/1250) were readmitted within 30 days; 55.5% of those readmissions were a result of cardiovascular disease. Anemia was noted in 62.2% of the patients (778/1250). From univariable analysis, the following factors were found to be associated with 30-day readmissions in heart failure patients: anemia (p = 0.008), female sex (p = 0.03), pulmonary edema (p = 0.013), hyponatremia (p = 0.005), atrial fibrillation or flutter (p = 0.04), hyperlipidemia (p = 0.042), antiarrhythmic medications (p < 0.0001), and Charlson Weighted Index of Comorbidity (CWIC) score (p < 0.0001). From multivariable analysis, heart failure patients who were readmitted within 30 days were more likely to be anemic (OR = 1.4, p = 0.029), hyponatremic (OR = 1.5, p = 0.007), have pulmonary edema on chest imaging during the index hospitalization (OR = 1.4, p = 0.033), prescribed antiarrhythmic medications (OR = 1.8, p = 0.002), and have higher CWIC scores (OR = 1.1, p = 0.001). <h3>Conclusions</h3> : In patients with heart failure, after controlling for other risk factors, anemic patients were 40% more likely to be readmitted within 30-days compared to non-anemic patients. Other independent predictors of 30-day readmissions included hyponatremia, pulmonary edema, antiarrhythmic medications, and CWIC score.

Abstract 13804: True Anemia in Heart Failure Patients: Peripheral Hematocrits Lack Sensitivity and Specificity as a Predictor of Measured Red Blood Cell Volumes in a Mixed-LVEF Cohort

Introduction: Anemia is a common and serious co-morbidity of heart failure (HF) that is undertreated, impacting outcomes for HF patients and the overall economics of HF. Studies have shown that anemia is associated with worse outcomes in HF, but to date interventional studies aimed at treating anemia in HF have failed to demonstrate conclusive outcome improvements. A common feature of past studies is that they generally defined anemia via a threshold of peripheral Hct (or via Hemoglobin, which has a direct linear relationship to Hct). Methods: In a recently published study of a mixed-LVEF cohort of 245 HF patients, red cell volume status relative to patient norms was quantified using direct blood volume analysis (BVA, Daxor, Oak Ridge, TN). We evaluated the suitability of a Hct for detecting true anemia (as measured by BVA) in this group. Although Hct was somewhat correlated (R 2 =0.43) with red cell volume (RCV) deviation from ideal (as measured directly by BVA), actual RCV status was heterogeneous. We performed an analysis of the specificity and sensitivity of Hct as an indicator of true anemia, defined as RCV &lt; 90% of normal value. Results: The distribution of true anemia is shown in Figure 1. Visual inspection shows mixed anemia status across a broad range of Hct values. We examined three Hct thresholds for determining true anemia. Two thresholds were defined based on deviations from normal Hct (M=45, F=40); a third threshold was chosen at 24 for both genders, corresponding to a common transfusion trigger. Using a moderate 10% deviation threshold yielded a sensitivity of 96%, but a specificity of only 50%, due to a False Positive (dilutional anemia) rate of 19%. Using a more extreme 25% deviation threshold yielded a specificity of 90%, but a sensitivity of only 62%, due to a False Negative (FN) rate of 23%. The transfusion trigger had a FN rate of 61%. Conclusions: Hct lacks sensitivity and specificity for detecting true anemia. Interventions for anemia in HF would benefit from BVA.

Iron deficiency contributes to resistance to endogenous erythropoietin in anaemic heart failure patients.

Abnormal endogenous erythropoietin (EPO) constitutes an important cause of anaemia in chronic diseases. We analysed the relationships between iron deficiency (ID) and the adequacy of endogenous EPO in anaemic heart failure (HF) patients, and the impact of abnormal EPO on 12-month mortality. We investigated 435 anaemic HF patients (age: 74 ± 10 years; males: 60%; New York Heart Association class I or II: 39%; left ventricular ejection fraction: 43 ± 17%). Patients with EPO higher than expected for a given haemoglobin were considered EPO-resistant whereas those with EPO lower than expected - EPO-deficient. ID was defined as serum ferritin <100 µg/L or 100-299 µg/L with transferrin saturation <20%. EPO-resistant patients (22%) had more advanced HF whereas those with EPO deficiency (57%) were more frequently females and had worse renal function. Lower serum ferritin (indicating depleted body iron stores) was related to higher EPO observed/predicted ratio when adjusted for significant clinical confounders, including C-reactive protein. One year all-cause mortality was 28% in patients with EPO resistance compared to 17% in patients with EPO deficiency and 10% in patients with adequate EPO (log-rank test for the comparison EPO resistance vs. adequate EPO: P=0.02). When adjusted for other prognosticators, there was still a trend towards increased 12-month mortality in patients with higher EPO level. Anaemic HF patients with endogenous EPO deficiency vs. resistance have different clinical and laboratory characteristics. In such patients, ID contributes to EPO resistance independently of inflammation.

Anaemia in Heart Failure Patients, Associated with Angiotensin - Renin - Aldosterone System Altering Medications.

Heart failure (HF) remains one of the most common diseases and one of the major causes of death worldwide. HF is often associated with other chronic diseases, most commonly with anemia. Anemia increases patients' mortality and lowers their quality of life. There are a few pathophysiological mechanisms that explain anemia in patients with HF – hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, chronic kidney disease, and impaired erythropoietin production and activity. Moreover, congestive HF is often treated with angiotensin-converting enzyme inhibitors and aldosterone receptors blockers, which could be linked to the development of anemia.

Rationale and Design of the ADIDAS Study: Association Between Dapagliflozin-Induced Improvement and Anemia in Heart Failure Patients

BackgroundHeart failure (HF) is one of the most serious health concerns worldwide. Anemia is a highly prevalent comorbidity and outcome predictor in HF patients. Sodium glucose co-transport 2 (SGLT2) inhibitors have been demonstrated to reduce the risk of cardiovascular death and HF hospitalization in HF patients.PurposeThis investigator-initiated, interventional, prospective, double-blind, multicenter study is designed to investigate whether anemia correction is one of the prerequisites and determinants related to the beneficial effects of dapagliflozin in HF patients.Methods and ResultsUp to 2030 HF participants receiving standard care will be randomly assigned to either oral dapagliflozin 10 mg once daily or placebo 10 mg once daily for 12 months. The primary outcome is the composite incidence of hospital admission for HF and all-cause death. Secondary outcomes include change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score and change in 6-min walk distance and hemoglobin level. Patients will be followed for 12 months after randomization.ConclusionsThe ADIDAS trial offers an opportunity to assess the hemoglobin change and association between hemoglobin change and readmissions due to heart failure and all-cause death in patients with heart failure treated with dapagliflozin or placebo. This study could highlight if dynamic hemoglobin change is related to the outcome for HF patients.Trial RegistrationClinicalTrials.gov; NCT04707261. Registration date, 2020/12/01, “retrospectively registered”

Hubungan antara Kelas Fungsional Gagal Jantung Kronik dengan Tingkat Keparahan Anemia pada Pasien di Rumah Sakit Atma Jaya

Pendahuluan: Diperkirakan ada 40 juta orang menderita gagal jantung (GJ) di dunia, di Indonesia ditemukan pada 13% populasi. Angka kejadian anemia pada GJ ditemukan berkisar antara 17-50%. Anemia diketahui dapat meningkatkan risiko mortalitas dan prognosis pada pasien GJ dan pengertian lebih akan mekanismenya akan meningkatkan efektivitas pengobatan.Metode: Penelitian ini bersifat observasional analitik dengan desain potong lintang. Data diambil dari rekam medis medis pasien GJ yang masuk dari tahun 2016-2018 dan dikelompokan berdasarkan New York Heart Association Functional Class (NYHA-FC) dan keparahan anemia (WHO anemia cut-off point). Hasil: Terdapat 81 pasien gagal jantung dengan anemia dianalisa dan terdiri atas 34,57% NYHA II, 24,69% NYHA III, dan 40,7% NYHA IV. Sebanyak 50,6% pasien masuk anemia ringan dan 49,4% anemia sedang. Tidak ditemukan anemia berat. Hasil analisis multivariat menunjukan kelas fungsional gagal jantung kronik tidak memiliki hubungan bermakna dengan tingkat keparahan anemia (p = 0,179).Kesimpulan: Kelas fungsional GJ kronik tidak memiliki hubungan dengan tingkat keparahan anemia. Pasien gagal jantung tanpa komplikasi gagal ginjal jarang ditemukan anemia berat.&#x0D;

The Prognostic Role of Anemia in Heart Failure Patients

Anemia is frequently observed in heart failure (HF) patients. The aim of this prospective study was to assess if it is an independent predictor of outcome or a marker of a worse clinical condition in these patients. The study included 134 heart failure patients aged over 18 years. The patients were divided into two groups, according to the presence or absence of anemia at hospital admission. Anemia was defined as a hemoglobin concentration of less than 12 g/dl for women and less than 13 g/dl for men. The endpoints were: length of hospitalization, all cause-death during hospitalization, and all-cause death and HF rehospitalizations at 1 year. Anemia occurred in 33% of HF patients. The HF patients with anemia were significantly older, had more often ischemic etiology of heart failure and atrial fibrillation, chronic kidney disease and 3 or more comorbidities. The length of hospitalization was similar between the two groups. Deaths during hospitalization occurred in 13% of anemic and in 3% of the nonanemic patients (P=0.04). During the 1- year follow-up, 45% of the anemic vs. 28% of the nonanemic patients were rehospitalized due to aggravated HF (P=0.04), and 14% of the anemic vs 20% of the nonanemic patients died (P=0.38). Anemia was strongly predictive for in-hospital and 1- year all-cause deaths in univariate analysis, but not in multivariate analysis. Anemia seems more a marker of a worse clinical condition, rather than an independent risk factor in HF.

Pulmonary Artery Systolic Pressure and Right Sided Heart Failure Symptoms: a Predictor for Progression of Iron Deficiency to Iron Deficiency Anemia in Heart Failure Patients

Pulmonary Artery Systolic Pressure and Right Sided Heart Failure Symptoms: a Predictor for Progression of Iron Deficiency to Iron Deficiency Anemia in Heart Failure Patients

Prevalence and spectrum of iron deficiency anaemia in heart failure patients

Background: To study the prevalence and pattern of iron deficiency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) &lt; 13g/dl in males and &lt;12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin &lt; 100 mg/L and functional ID was defined as normal serum ferritin (100–300 mg/L) with low TSAT (&lt;20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.

Anaemia in heart failure patients: the prevalence of haematinic deficiencies and the role of ACE inhibitors and aspirin doses as risk factors.

Background:Patients with heart failure often have comorbidities that alter the progression of heart failure and impact on prognosis. One such comorbidity is anaemia, and clinicians have started to appreciate the full gravity of its impact on heart failure patients. Yet, the extent of the problem is not fully understood, particularly the role of heart failure therapy itself as a risk factor for developing anaemia.Objective:This study aimed to investigate the prevalence of anaemia in a cohort of heart failure patients. The impact of using different ACEIs and different doses of aspirin was also explored, together with the prevalence of haematinic deficiencies.Methods:Medication lists and pathology results were examined to establish the prevalence of ACEIs use, and the use of aspirin at its most common doses of 100mg and 150mg, together with haematinic deficiencies. Multinomial logistic regression and the Student’s t-test were utilised for the analysis of data. Statistical significance was pre-set at p<0.05.Results:Ninety-six patients were eligible for analysis, with 26% having anaemia. The use of ACEIs had a RR of 17.4 for the presence of anaemia. Perindopril was associated with a RR of 20.8, while the use of ramipril was not significantly associated with such a high RR. Haematinic anaemia occurred only at a rate of 3.3%, but borderline deficiencies were found in more than a third of all patients. An aspirin dose of 150mg was associated with a higher risk for anaemia, compared to a dose of 100mg.Conclusions:ACEIs are associated with the presence of anaemia, with perindopril posing more risk than ramipril when used in heart failure patients. The dose of aspirin may also be a factor in the development of anaemia, with lower doses being safer. Despite the lack of high prevalence of haematinic anaemia among this cohort of patients, borderline haematinic deficiencies were common.

Erythropoietin response to anaemia in heart failure

Despite multiple factors correlating with the high prevalence of anaemia in heart failure, the prevailing mechanisms have yet to be established. The purpose of this study is to systematically review the literature and determine whether low circulating haemoglobin is primarily underlain by erythropoietin resistance or defective production in heart failure. We conducted a systematic search of MEDLINE since its inception until May 2017 for articles reporting erythropoietin and haemoglobin concentrations in heart failure patients not treated with erythropoietin-stimulating agents. The primary outcome was the mean difference in observed/predicted (O/P) erythropoietin ratio between heart failure patients and normal reference values. Meta-regression analyses assessed the influence of potential moderating factors. Forty-one studies were included after systematic review, comprising a total of 3137 stable heart failure patients with mean age and left ventricular ejection fraction ranging from 52 years to 80 years and 21% to 59%. The O/P erythropoietin ratio was below reference values in 24 of 25 studies in anaemic heart failure patients ( n = 1094, range = 0.49-1.05), whereas only one out of 16 studies in non-anaemic heart failure patients presented a low O/P erythropoietin ratio ( n = 2043, range = 0.91-1.97). In studies comparing anaemic versus non-anaemic heart failure patients ( n = 1531), the mean O/P erythropoietin ratio was consistently reduced in anaemic heart failure patients (mean difference = -0.68, 95% confidence interval = -0.78, -0.57; p < 0.001). In meta-regression, the O/P erythropoietin ratio was negatively associated with age, female sex, left ventricular ejection fraction, inflammation and disease severity. Anaemia in heart failure is overwhelmingly characterized by impaired erythropoietin production, which is exacerbated with age, female sex, left ventricular ejection fraction, inflammation and disease severity.

Anemia in severe heart failure patients: does it predict prognosis?

BackgroundAnemia is highly prevalent in heart failure (HF) patients. However, the prevalence, clinical impact and prognostic factor of anemia in heart failure patients is widely varies. The aim of this study was to evaluate the prevalence of anemia in patients with HF, to compare baseline clinical characteristic and outcomes of severe HF patients with and without anemia admitted to Gondar University Referral Hospital (GURH), Gondar, Ethiopia.MethodA retrospective cohort study was conducted and we assessed medical records of heart failure patients who were admitted Gondar University Referral Hospital in the period between December 02, 2010 and November 30, 2016. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Multivariate Cox regression was used to analyze independent predictors of mortality in all HF patients. P value less than 0.05 was considered statistically significant.ResultThree hundred and seventy patients participated in the study. The prevalence of anemia in the study cohorts was 41.90% and majority of the participants were females (64.59%). There was a significant difference in the level of hemoglobin, creatinine, and sodium among anemic and non-anemic patients. Anemic patients with HF tend to take angiotensin converting enzyme inhibitors (ACEI) less frequently. Kaplan Meier survival curves and Log rank test (P = 0.042) showed a significant difference in the prognosis of HF patients with anemia and non – anemic. More significant difference was observed (Log rank test, P = 0.001) in the study participants based on hemoglobin level. Furthermore, multivariate Cox regression showed: advanced age, levels of lower sodium and higher creatinine, and absences of medications like ACEI and Spironolactone independently predicted overall mortality.ConclusionHF patients with anemia tend to be older age, had lower hemoglobin and sodium level and higher creatinine value. Moreover, there was a significant difference in the prognosis between study cohorts, as anemic pateints tend to have a worse survival status . Even though, anemia is a significant risk marker, it is not an independent predictor of mortality in the current study.