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

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Abstract

Background

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.

Aim

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.

Methods

The design and main results of the study have been previously described. Patients were randomized within 2 days 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 90 days were investigated.

Results

The proportion of anemia in 1077 STRONG-HF patients at enrollment was 27.2%, while at 90 days, 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 90 days 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 90 days and reduced the rate of primary and secondary endpoints regardless of baseline hemoglobin.

Conclusion

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.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

Funding for the study was through a grant provided to the Heart Initiative by Roche Diagnostics International.

Author information

Authors and Affiliations

  1. Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Jelena Čelutkienė & Kamilė Čerlinskaitė-Bajorė

  2. Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France

    Gad Cotter, Alain Cohen-Solal, Etienne Gayat, Valentine Léopold, Benjamin Deniau, Alexandre Mebazaa & Beth Davison

  3. Heart Initiative, Durham, NC, USA

    Gad Cotter & Beth Davison

  4. Momentum Research Inc, Durham, NC, USA

    Gad Cotter, Christopher Edwards, Marianela Barros, Maria Novosadova, Koji Takagi & Beth Davison

  5. Cardiology, Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy

    Marianna Adamo, Marco Metra, Matteo Pagnesi & Daniela Tomasoni

  6. Department of Internal Medicine, Stadtspital Zurich, Zurich, Switzerland

    Mattia Arrigo

  7. Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland

    Jan Biegus & Piotr Ponikowski

  8. Emergency Institute for Cardiovascular Diseases “Prof. C.C.Iliescu”, University of Medicine “Carol Davila”, Bucharest, Romania

    Ovidiu Chioncel

  9. Department of Cardiology, APHP Nord, Lariboisière University Hospital, Paris, France

    Alain Cohen-Solal

  10. Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique

    Albertino Damasceno

  11. Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina

    Rafael Diaz

  12. National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece

    Gerasimos Filippatos

  13. Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France

    Etienne Gayat, Valentine Léopold, Benjamin Deniau & Alexandre Mebazaa

  14. Université de Lorraine, Nancy; INSERM, Défaillance Circulatoire Aigue Et Chronique; Service de Médecine Intensive Et Réanimation Brabois, CHRU de Nancy, 54511, Vandœuvre-Lès-Nancy, France

    Antoine Kimmoun

  15. Department of Emergency Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Peter S. Pang

  16. Murtala Muhammed Specialist Hospital / Bayero University Kano, Kano, Nigeria

    Hadiza Saidu

  17. Cape Heart Institute, Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

    Karen Sliwa

  18. Department of Cardiology, Medical Centre Groningen, Groningen, Netherlands

    Jozine M. Ter Maaten & Adriaan A. Voors

  19. National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore

    Carolyn S. P. Lam

  20. Baim Institute for Clinical Research, Boston, MA, USA

    Carolyn S. P. Lam

  21. University Medical Centre Groningen, Groningen, The Netherlands

    Carolyn S. P. Lam

Authors
  1. Jelena Čelutkienė
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  2. Kamilė Čerlinskaitė-Bajorė
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Correspondence to Jelena Čelutkienė.

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Conflict of interest

JC has received personal fees from Novartis, AstraZeneca, Boehringer Ingelheim, Roche Diagnostics, and Pfizer. KČB has received personal fees from AstraZeneca, Boehringer Ingelheim and Bayer. GC, CE, MB, MN, KT, BD are employees of Momentum Research, which has received grants for research from Abbott Laboratories, Amgen, Celyad, Cirius Therapeutics, Corteria Pharmaceuticals, Heart Initiative, Sanofi, Windtree Therapeutics, and XyloCor Therapeutics. GC and BD are directors of Heart Initiative, a non-profit organization. MAd has received speaker fees from Abbott Vascular and Medtronic. AC-S has received honoraria for lectures or consultancy from AstraZeneca, Novartis, Vifor, Bayer, Merck, Sanofi, Abbott, and Boehringer Ingelheim. OC received grants from Servier. AD works for the Faculty of Medicine, Eduardo Mondlane University (Maputo, Mozambique), which received research grants from the Heart Initiative for their participation in this study. RD has received supporting fees for coordination of STRONG-HF trial activities. GF has received lecture fees or was a committee member for trials and registries sponsored by Bayer, Vifor, Boehringer Ingelheim, Medtronic, Servier and Amgen. MP has received personal fees from Abbott Laboratories, AstraZeneca, Boehringer Ingelheim and Vifor Pharma. PSP has received grants or research contracts from American Heart Association, Roche, Siemens, Ortho Diagnostics, Abbott, Beckman Coulter, and Siemens; consulting fees from Roche; honoraria from WebMD; and he has financial interest in The Heart Course. KS has received grants from Medtronic, Servier, and Amylam and honoraria from MSD, Novartis, and Sanofi. CSPL is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Novo Nordisk and Roche Diagnostics; has served as consultant or on the Advisory Board/Steering Committee/Executive Committee for Alleviant Medical, Allysta Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol.

Myers Squibb, CardioRenal, CPC Clinical Research, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Quidel Corporation, Radcliffe Group Ltd, Recardio Inc, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics, and Us2.ai; and serves as cofounder and nonexecutive director of Us2.ai. AAV has received consultancy fees or research support from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Cytokinetics, Myocardia, Merck, Novartis, Novo Nordisk, and Roche Diagnostics. AM has received grants from Roche Diagnostics, Abbott Laboratories, 4TEEN4, and Windtree Therapeutics; honoraria for lectures from Roche Diagnostics, Bayer, and MSD; is a consultant for Corteria Pharmaceuticals, S-form Pharma, FIRE-1, Implicity, 4TEEN4, and Adrenomed; and is coinventor of a patent on combination therapy for patients having acute or persistent dyspnea. All other authors declare no competing interests.

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Čelutkienė, J., Čerlinskaitė-Bajorė, K., Cotter, G. et al. Insights on prevalence and incidence of anemia and rapid up-titration of oral heart failure treatment from the STRONG-HF study. Clin Res Cardiol (2024). https://doi.org/10.1007/s00392-024-02518-y

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