Impact of anemia on physical function and survival among patients with coronary artery disease

The prevalence of anemia in the patients who survived and died due to myocardial infarction (MI)

Introduction & Objective: Ischemia heart disease (IHD) is the most often met reason for losses in different communities. The most common reason of IHD is Atherosclerosis, and various etiologic factors such as high blood pressure, diabetes, smoking, and hyperlipidemia are involved in its development. Anemia is also considered another resulting reason of loss and morbidity in patients via IHD. Accordingly, the current paper aimed to determine the prevalence of anemia in patients who survived and died of myocardial infarction. Materials and Methods: The present research is of a case-control type, and the subjects were the patients with myocardial infarction admitted to Heart Ward of Hamadan Ekbatan Hospital within one year (2012-2013). The patients were divided into two categories of demised and survived after myocardial infarction, and in each 160-subject group, the prevalence of anemia with hemoglobin levels was investigated. Moreover, the demographic characteristics, ejection fraction, and patients' underlying medical conditions were also taken into account. The data obtained were analyzed by SPSS 15 software and chi-square test. Results: Of the 320 patients studied, 61 patients (19.1%) had anemia and 51 (83.6%) patients who were anemic had died. 31.7% of the deceased patients after MI were weak, while 6.3% of the survived patients after MI were anemic. Also, in all age and sex groups, anemia in the former patient group was higher than in the sustained group. The predominance of anemia was clearly greater in the women than in the men (P < 0.05). Conclusion: Based on the findings, there is a statistically clear variation in the prevalence of anemia in the former patient group after MI than in the group who survived after MI.

[Acute coronary syndrome in elderly patients: experience of Aix-en-Provence General Hospital]

INTRODUCTION

Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention.

METHODS AND RESULTS

To discuss these specificities, we realized a retrospective study involving patients aged more than 75years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P=0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS).

DISCUSSION AND CONCLUSION

Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent.

Recovery from hospital-acquired anemia after acute myocardial infarction and effect on outcomes

New-onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) is independently associated with poor outcomes. The patterns of recovery from HAA after AMI and their association with mortality and health status are unknown. In the prospective 24-center Translational Research Investigating Underlying disparities in acute myocardial infarction Patients' Health Status (TRIUMPH) registry, we identified 530 patients with AMI and HAA (defined as normal hemoglobin at admission with the development of anemia by discharge) who had a repeat, protocol-driven hemoglobin measurement at 1 month after discharge. The 1-month measures were used to define persistent (persistent anemia) and transient (anemia resolved) HAA. The patients' health status was assessed at 1, 6, and 12 months after AMI using the Short-Form 12 Physical Component Summary, and the health status of patients with persistent and transient HAA was compared using multivariate repeated measures regression analysis. Mortality was compared using the log-rank test and proportional hazards regression analysis. Overall, 165 patients (31%) developed persistent HAA. The adjusted mean Short-Form 12 Physical Component Summary scores at the follow-up visit were significantly lower in those with persistent HAA than in those with transient HAA (-2.0 points, 95% confidence interval -3.6 to -0.3; p = 0.02). During a median follow-up of 36 months, the crude mortality (13% vs 5%, p = 0.002) and multivariate-adjusted mortality (hazard ratio 2.08, 95% confidence interval 1.02 to 4.21, p = 0.04) was greater in patients with persistent HAA. In conclusion, HAA persists 1 month after discharge in nearly 1 of 3 patients and is associated with worse health status and greater mortality. Additional investigation is needed to understand whether HAA prevention, recognition, and treatment, particularly among those with persistent HAA, will improve outcomes.