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Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure

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Abstract

Anemia is a risk factor related to morbidity and mortality in patients with chronic heart failure (HF). Less is known about its influence in patients in an early stage of HF. Our aim is to investigate the prognostic role of anemia in patients initially hospitalized for acute HF. We reviewed all consecutive patients admitted within a 18-month period with a main diagnosis of acute HF. We collected demographic, clinical and treatment data. Anemia is defined as Hemoglobin <12/13 g/dL upon admission in female/male patients, respectively. 719 patients were included (55.5% female), with a mean age of 78.7 ± 9 years. Anemia was present in 59.6% of patients upon admission, with a mean Hb of 10.4 ± 1.4 g/dL. Multivariate analysis confirms the relationship between the presence of anemia and older age, a previous diagnostic history of diabetes, and the presence of chronic kidney disease. In-hospital mortality is similar for anemic and non-anemic patients (6.8 vs 3.8%, p = n.s.) However, the difference is significant when one-year mortality is evaluated (31% in anemic patients vs 19% in non-anemic patients, p < 0.001). Cox regression analysis confirms the association between anemia and higher risk of one-year mortality, as well as with older age and a higher Charlson comorbidity index. Our study confirms that the presence of anemia is an independent factor for mid-term (1-year) mortality even in patients experiencing a first admission due to acute HF.

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References

  1. Stamos TD, Silver MA (2010) Management of anemia in heart failure. Curr Opin Cardiol 25:148–154. doi:10.1097/HCO.0b013e3283357fe0

    Article  PubMed  Google Scholar 

  2. Cattadori G, Agostoni P, Corrà U, Sinagra G, Veglia F, Salvioni E, Bonomi A, La Gioia R, Scardovi AB, Ferraironi A, Emdin M, Metra M, Di Lenarda A, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Caravita S, Magrì D, Lombardi C, Frigerio M, Oliva F, Girola D, Mezzani A, Farina S, Mapelli M, Scrutinio D, Pacileo G, Apostolo A, Iorio A, Paolillo S, Filardi PP, Gargiulo P, Bussotti M, Marchese G, Correale M, Badagliacca R, Sciomer S, Palermo P, Contini M, Giannuzzi P, Battaia E, Cicoira M, Clemenza F, Minà C, Binno S, Passino C, Piepoli MF (2016) Heart failure and anemia: effects on prognostic variables. Eur J Intern Med 37:56–63. doi:10.1016/j.ejim.2016.09.011

    Article  PubMed  Google Scholar 

  3. Triposkiadis F, Giamouzis G, Parissis J, Starling RC, Boudoulas H, Skoularigis J, Butler J, Filippatos G (2016) Reframing the association and signi fi cance of co-morbidities in heart failure. Eur J Heart Fail 30:744–758

    Article  Google Scholar 

  4. Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, Drakos SG, Tsagalou EP, Maroulidis GD, Alexopoulos GP, Kanakakis JE, Anastasiou-Nana MI (2006) Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 48:2485–2489. doi:10.1016/j.jacc.2006.08.034

    Article  PubMed  Google Scholar 

  5. Meara EO, Rouleau JL, White M, Roy K, Blondeau L, Ducharme A, Neagoe PE, Sirois MG, Lavoie J, Racine N, Liszkowski M, Madore F, Tardif JC, De Denus S (2014) Heart failure with anemia novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Hear Fail 7:773–781. doi:10.1161/CIRCHEARTFAILURE.114.001100

    Article  Google Scholar 

  6. Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, Febo O, Ferrari R, Fucili A, Moratti R, Tramarin R, Tavazzi L (2005) Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 26:2232–2237. doi:10.1093/eurheartj/ehi388

    Article  CAS  PubMed  Google Scholar 

  7. Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XHT, Deswal A (2012) Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 59:998–1005. doi:10.1016/j.jacc.2011.11.040

    Article  PubMed  PubMed Central  Google Scholar 

  8. Moe GW, Ezekowitz JA, O’Meara E, Lepage S, Howlett JG, Fremes S, Al-Hesayen A, Heckman GA, Abrams H, Ducharme A, Estrella-Holder E, Grzeslo A, Harkness K, Koshman SL, McDonald M, McKelvie R, Rajda M, Rao V, Swiggum E, Virani S, Zieroth S, Arnold JMO, Ashton T, D’Astous M, Chan M, De S, Dorian P, Giannetti N, Haddad H, Isaac DL, Kouz S, Leblanc MH, Liu P, Ross HJ, Sussex B, White M (2015) The 2014 Canadian cardiovascular society heart failure management guidelines focus update: anemia, biomarkers, and recent therapeutic trial implications. Can J Cardiol 31:3–16. doi:10.1016/j.cjca.2014.10.022

    Article  PubMed  Google Scholar 

  9. Kalra PR, Collier T, Cowie MR, Fox KF, Wood DA, Poole-Wilson PA, Coats AJS, Sutton GC (2003) Haemoglobin concentration and prognosis in new cases of heart failure. Lancet. doi:10.1016/S0140-6736(03)13912-8

    PubMed  Google Scholar 

  10. Formiga F, Chivite D, Castañer O, Manito N, Ramón JM, Pujol R (2006) Anemia in new-onset congestive heart failure inpatients admitted for acute decompensation. Eur. J. Intern. Med. doi:10.1016/j.ejim.2005.11.015

    PubMed  Google Scholar 

  11. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446. doi:10.1056/NEJM197112232852601

    Article  CAS  PubMed  Google Scholar 

  12. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F, Disease K (2007) Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 772:766–772. doi:10.1373/clinchem.2006.077180

    Article  Google Scholar 

  13. WHO Scientific Group on Nutritional Anaemias (1968) World Health Organization., Nutritional anaemias: report of a WHO scientific group (meeting held in Geneva from 13 to 17 March 1967). http://whqlibdoc.who.int/trs/WHO_TRS_405_rus.pdf

  14. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 40:373–383. doi:10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  15. Díez-Ló Pez C, Lupó J, De Antonio M, Zamora E, Domingo M, Santesmases J, Troya M-I, Boldó M, Bayes-Genis A (2016) Hemoglobin Kinetics and Long-term Prognosis in Heart Failure Ciné tica de la hemoglobina y pronó stico a largo plazo en insuficiencia cardiaca. Rev Esp Cardiol. doi:10.1016/j.rec.2016.02.028

    Google Scholar 

  16. Young JB, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH, O’Connor CM, She L, Sun JL, Yancy CW, Fonarow GC (2008) Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (Insight from the OPTIMIZE-HF Registry). Am J Cardiol. doi:10.1016/j.amjcard.2007.07.067

    Google Scholar 

  17. Galvao M, Kalman J, Demarco T, Fonarow GC, Galvin C, Ghali JK, Moskowitz RM (2006) Gender differences in in-hospital management and outcomes in patients with decompensated heart failure: analysis from the acute decompensated heart failure national registry (ADHERE). J Card Fail. doi:10.1016/j.cardfail.2005.09.005

    PubMed  Google Scholar 

  18. Caughey MC, Avery CL, Ni H, Solomon SD, Matsushita K, Wruck LM, Rosamond WD, Loehr LR (2014) Outcomes of patients with anemia and acute decompensated heart failure with preserved versus reduced ejection fraction (from the ARIC Study Community Surveillance) HHS Public Access. Am J Cardiol 114:1850–1854. doi:10.1016/j.amjcard.2014.09.024

    Article  PubMed  PubMed Central  Google Scholar 

  19. Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Luscher TF, Bart B, Banasiak W, Niegowska J, Kirwan BA, Mori C, von Eisenhart Rothe B, Pocock SJ, Poole-Wilson PA, Ponikowski P (2009) Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 361:2436–2448. doi:10.1056/NEJMoa0908355

    Article  CAS  PubMed  Google Scholar 

  20. Ponikowski P, Van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD (2015) Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 36:657–668. doi:10.1093/eurheartj/ehu385

    Article  CAS  PubMed  Google Scholar 

  21. Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, Banasiak W, Filippatos G, Anker SD, Ponikowski P (2016) Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail. doi:10.1002/ejhf.473

    Google Scholar 

  22. Hfa A, Voors AA, Germany SDA, Uk JGFC, Uk AJSC, Harjola V, Germany VF, Poland EAJ, Uk PN, Germany BP, Uk JPR, Rosano GMC, Rutten FH (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution:2129–2200. doi:10.1093/eurheartj/ehw128

  23. Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R, Maggioni AP, McMurray JJV, O’Connor C, Pfeffer MA, Solomon SD, Sun Y, Tendera M, van Veldhuisen DJ (2013) RED-HF Committees, RED-HF Investigators, Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med 368:1210–1219. doi:10.1056/NEJMoa1214865

    Article  CAS  PubMed  Google Scholar 

  24. Silverberg DS, Wexler D, Blum M, Tchebiner JZ, Sheps D, Keren G, Schwartz D, Baruch R, Yachnin T, Shaked M, Schwartz I, Steinbruch S, Iaina A (2003) The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron. Nephrol Dial Transplant 18:141–146. doi:10.1093/ndt/18.1.141

    Article  CAS  PubMed  Google Scholar 

  25. Vullaganti S, Goldsmith J, Teruya S, Alvarez J, Helmke S, Maurer MS (2014) Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction. J Geriatr Cardiol 11:100–105. doi:10.3969/j.issn.1671-5411.2014.02.002

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Berry C, Poppe KK, Gamble GD, Earle NJ, Ezekowitz JA, Squire IB, Mcmurray JJV, Mcalister FA, Komajda M, Swedberg K, Maggioni AP, Ahmed A, Whalley GA, Doughty RN, Tarantini L (2016) Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis. QJM 109:377–382. doi:10.1093/qjmed/hcv087

    Article  CAS  PubMed  Google Scholar 

  27. Lupón J, Urrutia A, González B, Herreros J, Altimir S, Coll R, Prats M, Rey-Joly C, Valle V (2005) Prognostic significance of hemoglobin levels in patients with heart failure. Rev. Española Cardiol. 58:48–53. http://www.ncbi.nlm.nih.gov/pubmed/15680131

  28. Ezekowitz JA, McAlister FA, Armstrong PW (2003) Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12065 patients with new-onset heart failure. Circulation. doi:10.1161/01.CIR.0000052622.51963.FC

    Google Scholar 

  29. Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand S-LT, Curtis JP, Drye EE, Lichtman JH, Keenan PS, Kosiborod M, Krumholz HM, Krumholz Y (2010) Trends in length of stay and short-term outcomes among medicare patients hospitalized for heart failure: 1993–2008. JAMA 303:2141–2147. doi:10.1001/jama.2010.748

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tuppin P, Cuerq A, De Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F (2014) Two-year outcome of patients after a first hospitalization for heart failure: a national observational study. Arch Cardiovasc Dis. doi:10.1016/j.acvd.2014.01.012

    PubMed  Google Scholar 

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, Milan, Italy

    Margherita Migone de Amicis & Maria Domenica Cappellini

  2. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Margherita Migone de Amicis & Maria Domenica Cappellini

  3. Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy

    Margherita Migone de Amicis & Maria Domenica Cappellini

  4. Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain

    David Chivite, Xavier Corbella & Francesc Formiga

  5. Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain

    Xavier Corbella

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  1. Margherita Migone de Amicis
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Correspondence to Margherita Migone de Amicis.

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Migone de Amicis, M., Chivite, D., Corbella, X. et al. Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure. Intern Emerg Med 12, 749–756 (2017). https://doi.org/10.1007/s11739-017-1637-5

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