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Kotit S. Benefits of intravenous iron supplementation in heart failure. Glob Cardiol Sci Pract 2024; 2024:e202410. [PMID: 38746071 PMCID: PMC11090186 DOI: 10.21542/gcsp.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction: Iron deficiency (ID) is one of the most frequent comorbidities in patients with heart failure (HF) and is estimated to be present in up to 80% of acute patients regardless of their ejection fraction. Randomized controlled trials have shown that supplementary intravenous iron results in improved clinical outcomes; however, the current understanding of the effects of intravenous iron on morbidity and mortality remains limited. Study and results: The meta-analysis pooled individual participant data from three randomized placebo-controlled trials of ferric carboxymaltose (FCM) in adult patients (n = 4,501) with heart failure and iron deficiency (CONFIRM-HF, AFFIRM-AHF, and HEART-FID). FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalizations and cardiovascular death, with a rate ratio (RR 0.86; 95% CI 0.75 to 0.98; p = 0.029). FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalizations (RR 0.83; 95% CI 0.73 to 0.96; p = 0.009) and a 16% relative rate reduction in total heart failure hospitalizations (RR 0.84; 95% CI 0.71 to 0.98; p = 0.025). Lessons learned: The meta-analysis shows that in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of total cardiovascular hospitalization and cardiovascular mortality. These findings indicate that intravenous FCM should be considered in iron-deficient patients with heart failure and reduced or mildly reduced ejection fractions.
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van Dalen DH, Kragten JA, Emans ME, van Ofwegen-Hanekamp CEE, Klaarwater CCR, Spanjers MHA, Hendrick R, van Deursen CTBM, Brunner-La Rocca HP. Acute heart failure and iron deficiency: a prospective, multicentre, observational study. ESC Heart Fail 2021; 9:398-407. [PMID: 34862747 PMCID: PMC8788059 DOI: 10.1002/ehf2.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023] Open
Abstract
Aims The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. Methods and results In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100–299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median [interquartile range] 124 μg/L [56–247] to 150 μg/L [73–277]), transferrin saturation (15% [10–20] to 18% [12–27]), and iron levels (9 μmol/L [6–13] to 11 μmol/L [8–16]) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% [15–29]) and iron levels (to 13 μmol/L [9–17]) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation. Conclusions Iron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.
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Affiliation(s)
- Dirk H van Dalen
- Department of Cardiology, Jeroen Bosch Hospital, PO Box 90153, room B4.02.022, 's-Hertogenbosch, 5200ME, The Netherlands
| | - Johannes A Kragten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mireille E Emans
- Department of Cardiology, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands
| | | | | | - Mireille H A Spanjers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rémond Hendrick
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Cees Th B M van Deursen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,School of Cardiovascular Diseases (CARIM), University of Maastricht, Maastricht, The Netherlands
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McEwan P, Ponikowski P, Davis JA, Rosano G, Coats AJS, Dorigotti F, O'Sullivan D, Ramirez de Arellano A, Jankowska EA. Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF. Eur J Heart Fail 2021; 23:1687-1697. [PMID: 34191394 PMCID: PMC8596684 DOI: 10.1002/ejhf.2270] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/12/2023] Open
Abstract
Aims Iron deficiency is common in patients with heart failure (HF). In AFFIRM‐AHF, ferric carboxymaltose (FCM) reduced the risk of hospitalisations for HF (HHF) and improved quality of life vs. placebo in iron‐deficient patients with a recent episode of acute HF. The objective of this study was to estimate the cost‐effectiveness of FCM compared with placebo in iron‐deficient patients with left ventricular ejection fraction <50%, stabilised after an episode of acute HF, using data from the AFFIRM‐AHF trial from Italian, UK, US and Swiss payer perspectives. Methods and results A lifetime Markov model was built to characterise outcomes in patients according to the AFFIRM‐AHF trial. Health states were defined using the 12‐item Kansas City Cardiomyopathy Questionnaire (KCCQ‐12). Subsequent HHF were incorporated using a negative binomial regression model with cardiovascular and all‐cause mortality incorporated via parametric survival analysis. Direct healthcare costs (2020 GBP/USD/EUR/CHF) and utility values were sourced from published literature and AFFIRM‐AHF. Modelled outcomes indicated that treatment with FCM was dominant (cost saving with additional health gains) in the UK, USA and Switzerland, and highly cost‐effective in Italy [incremental cost‐effectiveness ratio (ICER) EUR 1269 per quality‐adjusted life‐year (QALY)]. Results were driven by reduced costs for HHF events combined with QALY gains of 0.43–0.44, attributable to increased time in higher KCCQ states (representing better functional outcomes). Sensitivity and subgroup analyses demonstrated data robustness, with the ICER remaining dominant or highly cost‐effective under a wide range of scenarios, including increasing treatment costs and various patient subgroups, despite a moderate increase in costs for de novo HF and smaller QALY gains for ischaemic aetiology. Conclusion Ferric carboxymaltose is estimated to be a highly cost‐effective treatment across countries (Italy, UK, USA and Switzerland) representing different healthcare systems.
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Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | - Jason A Davis
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University, London, UK
| | | | | | | | | | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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Abstract
Anemia is common in heart failure with preserved and reduced ejection fraction. It is independently associated with poor functional status, hospitalization, and reduced survival. Its etiology is complex and multifactorial. Hemodynamic and nonhemodynamic compensatory mechanisms have been discussed as a response to chronic anemia. Whether anemia is a risk marker of advanced disease or a risk factor for progressive heart failure is debated. Current guidelines recommend a diagnostic workup as a part of standard management. Studies investigating intravenous iron administration reported beneficial effects on clinical outcomes. This article reviews current information on anemia.
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Affiliation(s)
- Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila", Euroecolab; Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.
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Ponikowski P, Kirwan BA, Anker SD, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Haboubi T, Keren A, Khintibidze I, Kragten H, Martinez FA, McDonagh T, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Jankowska EA. Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure. Eur J Heart Fail 2019; 21:1651-1658. [PMID: 31883356 DOI: 10.1002/ejhf.1710] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Iron deficiency (ID) is a common co-morbidity in heart failure (HF), associated with impaired functional capacity, poor quality of life and increased morbidity and mortality. Treatment with intravenous (i.v.) ferric carboxymaltose (FCM) has shown improvements in functional capacity, symptoms and quality of life in stable HF patients with reduced ejection fraction. The effect of i.v. iron supplementation on morbidity and mortality in patients hospitalised for acute HF (AHF) and who have ID has yet to be established. The objective of the present article is to present the rationale and design of the AFFIRM-AHF trial (ClinicalTrials.gov NCT02937454) which will investigate the effect of i.v. FCM (vs. placebo) on recurrent HF hospitalisations and cardiovascular (CV) mortality in iron-deficient patients hospitalised for AHF. METHODS AFFIRM-AHF is a multicentre, randomised (1:1), double-blind, placebo-controlled trial which recruited 1100 patients hospitalised for AHF and who had iron deficiency ID defined as serum ferritin <100 ng/mL or 100-299 ng/mL if transferrin saturation <20%. Eligible patients were randomised (1:1) to either i.v. FCM or placebo and received the first dose of study treatment just prior to discharge for the index hospitalisation. Patients will be followed for 52 weeks. The primary outcome is the composite of recurrent HF hospitalisations and CV mortality. The main secondary outcomes include the composite of recurrent CV hospitalisations and CV mortality, recurrent HF hospitalisations and safety-related outcomes. CONCLUSION The AFFIRM-AHF trial will evaluate, compared to placebo, the effect of i.v. FCM on morbidity and mortality in iron-deficient patients hospitalised for AHF.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland.,Center for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland.,London School of Hygiene and Tropical Medicine, University College London, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Jarosław Drozdz
- Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Lodz, Poland
| | | | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andre Keren
- Assuta Hashalom Heart Institute, Assuta Hospitals, Tel-Aviv, Israel
| | | | | | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Córdoba, Argentina
| | | | - Marco Metra
- Cardiology, University of Brescia and Civil Hospital, Brescia, Italy
| | | | - José C Nicolau
- Faculdade de Medicina FMUSP, Instituto do Coracao (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcus Ohlsson
- Department of Nephrology and Transplantation, Skane University Hospital Malmoe, Malmo, Sweden
| | | | | | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Zürich, Switzerland
| | - David Sim
- National Heart Centre, Clinical Translational and Research Office, Singapore, Singapore
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Beirut, Lebanon
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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Jacob C, Altevers J, Barck I, Hardt T, Braun S, Greiner W. Retrospective analysis into differences in heart failure patients with and without iron deficiency or anaemia. ESC Heart Fail 2019; 6:840-855. [PMID: 31286685 PMCID: PMC6676442 DOI: 10.1002/ehf2.12485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/18/2019] [Accepted: 06/01/2019] [Indexed: 12/22/2022] Open
Abstract
Aims The aim of this study was to assess the burden of heart failure (HF) patients with/without iron deficiency/iron deficiency anaemia (ID/A) from the health insurance perspective. Methods and results We conducted a retrospective claims database analysis using the Institut für angewandte Gesundheitsforschung Berlin research database. The study period spanned from 1 January 2012 to 31 December 2014. HF patients were identified by International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification codes (I50.‐, I50.0‐, I50.00, I50.01, I50.1‐, I50.11, I50.12, I50.13, I50.14, I50.19, and I50.9). HF patients were stratified into HF patients without ID/A and HF patients with ID/A (D50.‐, D50.0, D50.8, D50.9, and E61.1). HF patients with ID/A were stratified into three subgroups: no iron treatment, oral iron treatment, and intravenous iron treatment. A matching approach was applied to compare outcomes for HF patients without ID/A vs. HF patient with untreated incident ID/A without iron treatment and for HF patients receiving no iron treatment vs. oral iron treatment vs. intravenous iron treatment. Matching parameters included exact age, sex, and New York Heart Association functional class. An optimization algorithm was used to balance total health care costs in the baseline period for the potential matched pairs without sample size reduction. In total, 172 394 (4537.4 per 100 000) HF patients were identified in the Institut für angewandte Gesundheitsforschung Berlin research database in 2013. Of these, 11.1% (19 070; 501.9 per 100 000) were diagnosed with ID/A and/or had a prescription for iron medication in 2013. The mean age of HF patients was 77.0 years (±12.0 years). Women were more frequently diagnosed with HF (54.6%). HF patients with untreated incident ID/A (1.77%) had a significantly higher all‐cause mortality than HF patients without ID/A (33.1% vs. 24.1%, P < 0.01). The analysis of health care utilization revealed significant differences in the rate of all‐cause hospitalization (72.9% vs. 50.5%, P < 0.01). The annual health care costs for HF patients with untreated incident ID/A amounted to €17 347 with incremental costs of €849 (P < 0.01) attributed to ID/A. Conclusions Heart failure is associated with a major burden for patients and the health care system in terms of health care resource utilization, costs, and mortality. Our findings suggest that there is an unmet need for treating more HF patients with ID/A with iron medication.
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Affiliation(s)
| | | | - Isabella Barck
- Vifor Pharma and Vifor Fresenius Medical Care Renal Pharma, Munich, Germany
| | - Thomas Hardt
- Vifor Pharma and Vifor Fresenius Medical Care Renal Pharma, Munich, Germany
| | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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Zusman O, Itzhaki Ben Zadok O, Gafter-Gvili A. Management of Iron Deficiency in Heart Failure. Acta Haematol 2019; 142:51-56. [PMID: 30970349 DOI: 10.1159/000496822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/11/2019] [Indexed: 12/17/2022]
Abstract
Anemia is a common finding in patients with heart failure (HF). The cause for anemia is multifactorial, with iron deficiency being the most common cause. Anemia with HF is an established predictor of morbidity and mortality. Iron deficiency in systolic HF, even without anemia, has been associated with increased mortality, increased hospitalizations, and decreased functional capacity and quality of life measures. Data from several randomized controlled trials and meta-analyses of iron deficiency and systolic HF show a beneficial effect for intravenous (IV) iron in terms of quality of life and functional capacity (improvements in 6-min walk test, and improvements in New York Heart Association functional class), as well as decreased hospitalizations for HF and reduction in cardiovascular mortality rates. Limited evidence exists for a beneficial effect of IV iron in diastolic dysfunction. Patients with symptomatic systolic HF should undergo an anemia diagnostic work-up. When iron deficiency (defined as ferritin <100 ng/mL or serum ferritin 100-299 ng/mL and transferrin saturation <20%) is present, current evidence supports treating HF patients with iron deficiency with IV iron.
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Affiliation(s)
- Oren Zusman
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
- Department of Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel,
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel,
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Kyriakou M, Kiff P. Prognosis of the comorbid heart failure and Anemia: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Hohmuth B, Ozawa S, Ashton M, Melseth RL. Patient-centered blood management. J Hosp Med 2014; 9:60-5. [PMID: 24282018 DOI: 10.1002/jhm.2116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/18/2013] [Accepted: 10/25/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. METHODS We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. RESULTS PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. CONCLUSION PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM.
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Affiliation(s)
- Benjamin Hohmuth
- Department of Hospital Medicine, Geisinger Medical Center, Danville, Pennsylvania
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Association between left ventricular dysfunction, anemia, and chronic renal failure. Analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) cohort. Herz 2013; 40:616-23. [PMID: 24218037 DOI: 10.1007/s00059-013-3967-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anemia and chronic renal failure (CRF) are frequent comorbidities in patients with heart failure (HF), and they have been reported to be associated with increased mortality and hospitalization rates. HF, anemia, and CRF have been reported to interact with each other forming a vicious cycle termed cardio-renal-anemia syndrome. The aim of the present study was to evaluate the association of HF, anemia, and CRF using data from the large-scale"Heart Failure Prevalence and Predictors in Turkey (HAPPY)" study. PATIENTS AND METHODS Among the HAPPY cohort, 3,369 subjects who had either left ventricular dysfunction (LVD) or normal left ventricular function on echocardiography or normal serum NT-proBNP levels were included in this analysis. RESULTS The prevalence of anemia and CRF was significantly higher in patients with LVD compared with subjects with normal ventricular function (20.7 % vs. 4.0 % and 19.0 % vs. 3.7 %, respectively; p < 0.001 for each). Binary logistic regression analyses for the presence of LVD, anemia, and CRF demonstrated that each one was an independent predictor for the presence of the others. CONCLUSION These findings point to the presence of cardio-renal-anemia syndrome and the necessity of treating these comorbidities in patients with HF.
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11
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Ozawa S. Patient Blood Management: Use of Topical Hemostatic and Sealant Agents. AORN J 2013; 98:461-78. [DOI: 10.1016/j.aorn.2013.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/06/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
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12
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Commentary on “Prevalence and Impact of Anemia in Hospitalized Patients”. South Med J 2013; 106:207-8. [DOI: 10.1097/smj.0b013e318287fee3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rovellini A, Graziadei G, Folli C, Brambilla AM, Cosentini R, Canetta C, Monzani V. Causes and correlates of anemia in 200 patients with acute cardiogenic pulmonary edema. Eur J Intern Med 2012; 23:733-7. [PMID: 22818627 DOI: 10.1016/j.ejim.2012.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute heart failure has a poor prognosis and the presence of anemia may increase the risk of adverse outcomes. However, the clinical and laboratory characteristics of anemia in acute heart failure are poorly known. We aimed to assess the causes and the clinical and laboratory correlates of anemia in patients with acute cardiogenic pulmonary edema (ACPE). METHODS This observational study, performed in an Emergency Unit, enrolled 200 patients treated with medical therapy and continuous positive airway pressure. RESULTS Anemia was found in 36% of patients (38.5% of females and 32.5% of males) and was severe (hemoglobin <9 g/dL) in 6.9% of cases. The most frequent causes of anemia were chronic renal failure (27.8%), chronic inflammatory states (27.8%) and the clustering of multiple factors (18.1%). A wider spectrum of etiological factors was found in females than in males. Microcytic anemia was observed only in females (20% of those anemic), mainly due to iron deficiency/chronic blood loss. Glomerular filtration rate, serum iron, serum albumin, total cholesterol and diastolic blood pressure were independently associated with hemoglobin levels. CONCLUSIONS The etiology of anemia in ACPE is heterogeneous, with several causal factors besides impaired renal function. The pattern of anemia is different between genders, suggesting that sex-specific diagnostic and therapeutic targets should be implemented.
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Affiliation(s)
- Angelo Rovellini
- Emergency Medicine Unit, Department of Medicine and Medical Specialties, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
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Malyszko J, Zbroch E, Malyszko J, Mysliwiec M, Iaina A. The cardio-renal-anaemia syndrome predicts survival in peritoneally dialyzed patients. Arch Med Sci 2010; 6:539-44. [PMID: 22371797 PMCID: PMC3284068 DOI: 10.5114/aoms.2010.14465] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 11/05/2009] [Accepted: 11/17/2009] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Anaemia is one of the arms of the cardio-renal-anaemia syndrome (CRA) in chronic kidney disease (CKD) patients. The correction of anaemia was effective in the amelioration of both cardiac and renal failure. We studied the relationship between the severity of CRA syndrome in peritoneally dialyzed patients and their survival probability. MATERIAL AND METHODS Fifty-six patients on peritoneal dialysis were followed for 1 year. Definition of the severity of the CRA in dialysis patients: cardiac arm - NYHA class I-IV = 1-4 points, renal arm - non-diabetic patients age < 65 =1 point, non-diabetic patients age>65 = 2 points, diabetic patients age < 65 = 3 points, diabetic patients age>65 = 4 points, anaemia arm - Hb 11-13 g/dl (male), 11-12 g/dl (female) = 1 point, Hb 10-11 g/dl = 2 points, Hb 9-10 g/dl = 3 points, Hb < 9 g/dl = 4 points. The severity score = cardiac + renal + anaemia arms score divided by 3 (maximum 4 points). RESULTS A total of 10/56 patients (18%) died during the study. The median value for the severity score of the whole group was 1.69. In Kaplan-Meier analysis CRA severity score was strongly associated with mortality (p < 0.001). It also correlated with albumin, CRP, erythropoietin treatment, Hb and fasting glucose. In the multivariate regression analysis age, Hb, albumin, and presence of diabetes remained significant predictors of death. CONCLUSIONS The severity score of CRA syndrome in peritoneally dialyzed patients is an independent and very significant predictor of death. The patients with a high severity score had more hypoalbuminaemia, higher inflammation markers and higher prevalence of diabetes and chronic heart failure. Cardio-renal-anaemia syndrome severity scoring as defined by us could be an easy tool to predict outcome of dialysis patients.
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Affiliation(s)
- Jolanta Malyszko
- Department of Nephrology and Transplantology, Medical University, Bialystok, Poland
| | - Edyta Zbroch
- Department of Nephrology and Transplantology, Medical University, Bialystok, Poland
| | - Jacek Malyszko
- Department of Nephrology and Transplantology, Medical University, Bialystok, Poland
| | - Michal Mysliwiec
- Department of Nephrology and Transplantology, Medical University, Bialystok, Poland
| | - Adrian Iaina
- APC Health-Specialists Clinics, Benei Berak, Israel
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Przybylowski P, Malyszko J, Malyszko J. Anemia Is a Predictor of Outcome in Heart Transplant Recipients. Transplant Proc 2009; 41:3228-31. [DOI: 10.1016/j.transproceed.2009.07.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Terrovitis JV, Anastasiou-Nana M, Kaldara E, Drakos SG, Nanas SN, Nanas JN. Anemia in heart failure: pathophysiologic insights and treatment options. Future Cardiol 2009; 5:71-81. [PMID: 19371205 DOI: 10.2217/14796678.5.1.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anemia has been recognized as a very common and serious comorbidity in heart failure, with a prevalence ranging from 10 to 79%, depending on diagnostic definition, disease severity and patient characteristics. A clear association of anemia with worse prognosis has been confirmed in multiple heart failure trials. This finding has recently triggered intense scrutiny in order to identify the underlying pathophysiology and the best treatment options. Etiology is multifactorial, with iron deficiency and cytokine activation (anemia of chronic disease) playing the most important roles. Treatment is aimed at not only restoring hemoglobin values back to normal, but also at improving the patient's symptoms, functional capacity and hopefully the outcome. Iron supplementation and erythropoietin-stimulating agents have been used for this purpose, either alone or in combination. In this review, the recent advances in elucidating the mechanisms leading to anemia in the setting of heart failure are presented and the evidence supporting the use of different treatment approaches are discussed.
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Affiliation(s)
- John V Terrovitis
- 3rd Cardiology Department, University of Athens, School of Medicine, Athens, Greece.
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Prognostic Utility of Anemia and Pro-B-Type Natriuretic Peptide in Patients With Nonischemic Dilated Cardiomyopathy and Normal Renal Function. Am J Med Sci 2009; 337:109-15. [DOI: 10.1097/maj.0b013e31818128b5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Hospitalized heart failure (HF) patients experience high rehospitalization rates. Predicting early rehospitalization risk in HF patients may enable better decision making at time of hospital discharge. It is known that sex and ethnicity influence rehospitalization rates. Several measures easily and conveniently obtained before discharge are arterial oxygen saturation (SaO2) and distance walked during the 6-minute walk test (6MWT). RESEARCH OBJECTIVE The aim of this pilot study was to examine sociodemographic (sex and ethnicity) and clinical (oxygenation and distance walked) variables obtained during a predischarge 6MWT that could indicate increased risk of cardiac rehospitalization within 90 days. METHODS Within 24 hours of discharge, 44 hospitalized HF patients underwent 6MWT with continuous SaO2 and heart rate monitoring. Demographic data, past medical history, and medication use were collected from the patients' charts. RESULTS Participants' mean (SD) age was 59.6 (18.6) years, with half (n = 22) being Caucasian/white and one-quarter (n = 11) being married. Half (n = 22) were anemic on admission. Mean (SD) SaO2 was 94.2% (3.6%), mean (SD) minimum SaO2 was 89.1% (6.1%), and mean (SD) 6MWT was 220.8 (111.6) m. More than half (n = 23) were rehospitalized for cardiac reasons. Women had a 2.5 times greater risk of rehospitalization than men did. Women were significantly more anemic and walked shorter distances. There was no relation between distance walked or SaO2 and rehospitalization risk. CONCLUSION Although there was no relation between SaO2 and rehospitalization risk, women had a greater risk of rehospitalization, were more frail, and were more often anemic. This study is novel because it establishes a link between sex, anemia, functional status, and rehospitalization risk in patients hospitalized for HF. More research is needed to better understand the influence of anemia, functional status, and sex in relation to rehospitalization risk.
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Abstract
The most severe consequence of iron depletion is iron deficiency anemia (IDA), and it is still considered the most common nutrition deficiency worldwide. Although the etiology of IDA is multifaceted, it generally results when the iron demands by the body are not met by iron absorption, regardless of the reason. Individuals with IDA have inadequate intake, impaired absorption or transport, physiologic losses associated with chronological or reproductive age, or chronic blood loss secondary to disease. In adults, IDA can result in a wide variety of adverse outcomes including diminished work or exercise capacity, impaired thermoregulation, immune dysfunction, GI disturbances, and neurocognitive impairment. In addition, IDA concomitant with chronic kidney disease or congestive heart failure can worsen the outcome of both conditions. In this review, the prevalence of IDA related to confounding medical conditions will be described along with its diverse etiologies. Distinguishing IDA from anemia of chronic disease using hematologic measures is reviewed as well. In addition, current diagnostic strategies that are inclusive of clinical presentation, biochemical tests, and differential diagnosis will be outlined, followed by a discussion of treatment modalities and future research recommendations.
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Affiliation(s)
- Susan F Clark
- Virginia Polytechnic Institute and State University, Department of Human Nutrition, Foods and Exercise, Blacksburg, VA 24061, USA.
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Ramel A, Jonsson PV, Bjornsson S, Thorsdottir I. Anemia, nutritional status, and inflammation in hospitalized elderly. Nutrition 2008; 24:1116-22. [PMID: 18692363 DOI: 10.1016/j.nut.2008.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 03/05/2008] [Accepted: 05/31/2008] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Anemia (hemoglobin <120 g/L) in elderly patients is a health problem. The aim of this study was to investigate the prevalence of anemia and associations of anemia with nutritional status and inflammation in hospitalized elderly. METHODS Sixty patients from the Department of Geriatrics were randomly assigned to participate. Blood samples were drawn and analyzed at the laboratory of the University Hospital in Reykjavik. Nutritional status was assessed using anthropometric and hematologic parameters. RESULTS The prevalence of anemia was 36.7%. Female participants were more frequently anemic than male participants (47.4% versus 18.2%, P = 0.024). Anemic patients had a lower albumin level (31.3 versus 33.4 g/L, P = 0.019) and a higher erythrocyte sedimentation rate (29.6 versus 16.0 mm/h, P = 0.005) and were more often malnourished (81.8% versus 44.7%, P = 0.005) than non-anemic patients. Hemoglobin correlated with prealbumin (rho = 0.338, P = 0.008) and albumin (rho = 0.250, P = 0.054) levels, but negatively with age (rho = -0.310, P = 0.016) and erythrocyte sedimentation rate (rho = -0.412, P < 0.001). In the multivariate analysis, erythrocyte sedimentation rate and nutritional status were significant predictors of hemoglobin (R(2) = 34.0%). CONCLUSION This cross-sectional analysis provides evidence of anemia in 36.7% of patients hospitalized at the Landspitali-University Hospital in Reykjavik and shows an association among anemia, deteriorated nutritional status, and inflammation. Future prospective studies are needed to assess the efficacy of adjuvant nutritional support to stabilize or improve nutritional status including anemia in hospitalized elderly.
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Affiliation(s)
- Alfons Ramel
- Unit for Nutrition Research, Landspitali-University Hospital, and Department of Food Science and Human Nutrition, University of Iceland, Reykjavik, Iceland.
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The synergistic combined effect of anemia with high plasma levels of B-type natriuretic peptide significantly predicts an enhanced risk for major adverse cardiac events. Heart Vessels 2008; 23:243-8. [DOI: 10.1007/s00380-007-1034-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 12/08/2007] [Indexed: 10/21/2022]
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Silverberg DS, Wexler D, Iaina A, Schwartz D. The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron? ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1778-428x.2005.tb00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Pagourelias ED, Koumaras C, Kakafika AI, Tziomalos K, Zorou PG, Athyros VG, Karagiannis A. Cardiorenal anemia syndrome: do erythropoietin and iron therapy have a place in the treatment of heart failure? Angiology 2008; 60:74-81. [PMID: 18413330 DOI: 10.1177/0003319708316169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The cardiorenal anemia syndrome in congestive heart failure (CHF) is an independent risk factor for vascular morbidity and mortality. Several factors play a role in the pathogenesis of anemia in CHF, including inflammation, impaired renal function, use of certain antihypertensive or cardioprotective agents, and gastrointestinal or urinary losses of essential hemopoietic factors. Several trials evaluated the effects of administering erythropoietin (EPO) and/or iron to patients with CHF. Even though most of them were uncontrolled studies, their results suggest that EPO treatment might be beneficial in CHF. Nevertheless, more studies are needed and certain issues should be resolved, particularly the optimal hemoglobin level, before EPO can become part of the treatment of patients with CHF.
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Affiliation(s)
- Efstathios D Pagourelias
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Taegtmeyer AB, Rogers P, Breen JB, Barton PJ, Banner NR, Yacoub MH. The Effects of Pre- and Post-transplant Anemia on 1-Year Survival After Cardiac Transplantation. J Heart Lung Transplant 2008; 27:394-9. [DOI: 10.1016/j.healun.2008.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/27/2007] [Accepted: 01/12/2008] [Indexed: 11/16/2022] Open
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The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes. Heart Fail Rev 2008; 13:387-92. [PMID: 18246424 DOI: 10.1007/s10741-008-9089-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
This review article summarizes the current medical literature reporting on the prevalence and prognostic significance of anemia in patients with heart failure. Almost all currently available data indicate that anemia is common in heart failure populations, with the majority of studies indicating prevalence >20%. Anemia appears to be more highly prevalent in patients with advanced age, with more severe limitations in functional capacity, and with greater severity of co-morbid chronic kidney disease. In most reported studies anemia is an independent predictor of increased mortality risk and increased risk of hospitalization for heart failure. These data provide the rationale for interventional treatment trials to determine if anemia is in the causal pathway for disease progression and increased mortality risk in HF patients.
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Petretta M, Scopacasa F, Fontanella L, Carlomagno A, Baldissara M, de Simone A, Petretta MP, Bonaduce D. Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2007; 8:909-16. [PMID: 17906476 DOI: 10.2459/jcm.0b013e32801464b6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the prognostic value of B-type natriuretic peptide (N-proBNP), renal dysfunction and anemia in chronic heart failure (CHF) patients. METHODS We analyzed data from a prospective cohort of 153 patients (mean age 64 years) with CHF referred to our hospital center. Clinical, echocardiographic and laboratory data were drawn during hospital recovery in all patients. Kidney dysfunction was defined as a glomerular filtration rate (GFR) < 60 ml/min and anemia as a hematocrit < 35%. After discharge, patients attended the outpatient clinic of our institution. RESULTS Kidney dysfunction was diagnosed in 37% of cases, whereas anemia was present in 25% of patients. During follow-up (median time 456 days), 32 patients died. Multivariate Cox proportional hazard model revealed that N-proBNP [hazard ratio (HR) = 1.002; P < 0.001] and GFR (HR = 0.972; P < 0.005) were significant predictors for mortality after adjustment for confounding variables. Kaplan-Maier analysis demonstrated a progressive decrease in survival from lowest to highest tertiles of N-proBNP values (log rank = 28.7; P < 0.001) and from higher to lower GFR values (log rank = 5.63; P < 0.01). Moreover, parametric survival analysis by the Weibull model demonstrated that the estimated probability of survival adjusted for N-proBNP values was higher in patients with GFR > or = 60 ml/min than in those with GFR < 60 ml/min (P < 0.001). CONCLUSION Increased N-proBNP and decreased kidney function, but not anemia, are independent risk factors for mortality in patients with CHF.
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Affiliation(s)
- Mario Petretta
- Department of Internal Medicine, Cardiology, Heart Surgery and Immunological Sciences, University of Naples Federico II, Via S Pansini no. 5, Naples, Italy
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Silva RP, Barbosa PHU, Kimura OS, Sobrinho CRMR, Sousa Neto JD, Silva FAL, Silva Júnior GB, Mota RMS, Daher EF. Prevalance of anemia and its association with cardio-renal syndrome. Int J Cardiol 2007; 120:232-6. [PMID: 17174420 DOI: 10.1016/j.ijcard.2006.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 08/15/2006] [Accepted: 10/01/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anemia is common in cardio-renal syndrome and may contribute to increase mortality. OBJECTIVE To examine the prevalence of anemia and its relationship with cardio-renal syndrome, and to evaluate the risk factors for death. METHODS Retrospective study with all patients admitted with congestive heart failure (CHF). The parameters as age, gender, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA) functional class, ejection fraction (EF%), hospital stay, hypertension, diabetes, smoking and CHF etiology were analyzed. Anemia was defined as Hb<12 g/dL, systolic dysfunction EF<55% and renal failure was stratified according to K-DOQI classification. Statistical analysis was done by the programs EpiInfo and SPSS for windows. RESULTS A total of 174 patients were studied. The average age was 63+/-16 years, 65.5% were males, and 18 of them (11%) were non-survivors. Anemia was observed in 45% of patients, and 82% presented some degree of renal failure. The majority of patients (87%) were classified as NYHA functional class III or IV. The average ejection fraction was 43.9+/-16.6%, and there was no difference between survivors and non-survivors (p>0.05). Mortality was not significantly higher among patients with anemia (12.4%) when comparing to those without anemia (8.3%, p=0.31). There was a progressive decrease in the level of hemoglobin as renal function decreased (p<0.05). Increased serum creatinine was a significant risk factor for death (OR=1.59, 95% CI=1.074-2.363, p=0.021), and increased EF% was a protection factor against development of death (OR=0.904, 95% CI=0.845-0.973, p=0.007). CONCLUSIONS The prevalence of anemia is high among patients with cardio-renal syndrome but was not associated with increased mortality. Increased serum creatinine and low EF% were variables associated with death.
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Affiliation(s)
- Ricardo P Silva
- Division of Cardiology, Hospital Universitário Walter Cantídio, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
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28
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Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D. Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 2007; 38:295-310. [PMID: 16868702 DOI: 10.1007/s11255-006-0064-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2005] [Indexed: 12/31/2022]
Abstract
Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, poor quality of life (QoL), progressive chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin production and on bone marrow activity, as well as to their interference with iron absorption from the gut and their inhibiting effect on the release of iron from iron stores. Anemia itself may further worsen cardiac and renal function and make the patients resistant to standard CHF therapy. Indeed anemia in CHF has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, the need for higher doses of diuretics, progressive worsening of renal function and reduced QoL. In both controlled and uncontrolled studies of CHF, the correction of the anemia with erythropoietin (EPO) and oral or intravenous (IV) iron has been associated with improvement in many cardiac and renal parameters and an increased QoL. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia--by reducing apoptosis of cardiac and endothelial cells, increasing the number of endothelial progenitor cells, and improving endothelial cell function and neovascularization of the heart. Anemia may also play a role in the worsening of acute myocardial infarction and chronic coronary heart disease (CHD) and in the cardiovascular complications of renal transplantation. Anemia, CHF and CKD interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only adequate treatment of all three conditions can prevent the CHF and CKD from progressing.
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Affiliation(s)
- Donald S Silverberg
- Department of Nephrology, Tel Aviv Medical Center, Weizman 6, 64239, Tel Aviv, Israel.
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Kerzner R, Gage BF, Rich MW. Anemia Does Not Predict Mortality in Elderly Patients With Heart Failure. ACTA ACUST UNITED AC 2007; 16:92-6. [PMID: 17380618 DOI: 10.1111/j.1076-7460.2007.05515.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent studies suggest that anemia is an independent predictor of adverse outcomes in patients with heart failure (HF), but the importance of anemia in elderly HF patients is unclear. To investigate this relationship, the authors quantified the prognostic importance of anemia in elderly vs younger patients with HF was performed. A chart review of 359 patients hospitalized in 1999 with HF was performed. Patients were categorized based on their hemoglobin (Hgb) level (<11.5, 11.5-13.4, >13.4 g/dL), and the authors used time-to-event analyses to test the hypothesis that Hgb predicted mortality over a mean follow-up of 25 months. Lower Hgb predicted worse survival in patients younger than 75 years (n=204; P=.03), but there was no correlation between Hgb level and mortality in patients 75 or older (n=155; P not significant). The authors conclude that anemia is not an important predictor of long-term survival in very elderly patients hospitalized with HF.
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Affiliation(s)
- Roger Kerzner
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
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Sánchez-Torrijos J, Gudín-Uriel M, Nadal-Barangé M, Jacas-Osborn V, Trigo-Bautista A, Giménez-Alcalá M, Payá-Serrano R, Ridocci-Soriano F. Valor pronóstico de las cifras de hemoglobina en el momento del alta en pacientes hospitalizados por insuficiencia cardiaca. Rev Esp Cardiol 2006. [DOI: 10.1157/13096601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Solid CA, Foley RN, Gilbertson DT, Collins AJ. Anemia and Cost in Medicare Patients With Congestive Heart Failure. ACTA ACUST UNITED AC 2006; 12:302-6. [PMID: 17170582 DOI: 10.1111/j.1527-5299.2006.00127.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine the total cost to Medicare associated with the presence of anemia in congestive heart failure (CHF) patients. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify anemia, CHF, and comorbid conditions in 2002, and total Medicare costs were calculated for 2003. The mean patient age was 77.8 years. Anemia, present in 32% of CHF patients, was associated with older age, female sex, non-white race, and increasing burden of comorbidity. The total per-member-per-month cost in 2003 was $1781.01 among CHF patients with anemia in the preceding year compared with $1142.38 for CHF patients without anemia, a ratio of 1.56 (95% confidence interval, 1.5589-1.5592). When adjustment was made for baseline demographic factors and comorbid conditions, the corresponding ratio was 1.25 (95% confidence interval, 1.2546-1.2548). Anemia, a common association of CHF in elderly patients, is an antecedent association of increased societal medical expenditure.
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Affiliation(s)
- Craig A Solid
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minnesota, Minneapolis, MN 55404, USA
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Falk K, Swedberg K, Gaston-Johansson F, Ekman I. Fatigue and anaemia in patients with chronic heart failure. Eur J Heart Fail 2006; 8:744-9. [PMID: 16690352 DOI: 10.1016/j.ejheart.2006.01.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 11/08/2005] [Accepted: 01/26/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Fatigue is common in patients with chronic heart failure (CHF) and has great impact on functional ability and daily activity. Although anaemia is associated with fatigue, the relationship between fatigue and anaemia is unclear in CHF. The aim of this study was to describe the fatigue experience and its relationship to haemoglobin (Hb) concentration and to evaluate its effect on health-related quality of life in an unselected hospitalised CHF population. METHODS Ninety three consecutive patients hospitalised with a diagnosis of CHF, enrolled in the EuroHeart Failure Survey, completed the Multidimensional Fatigue Inventory Scale (MFI-20). New York Heart Association (NYHA) functional class, quality of life and haemoglobin were also assessed. RESULTS Anaemia (Hb < or = 125 g/L) was found in 31 (33%) patients. The perception of fatigue differed significantly between patients with CHF and healthy individuals. Anaemic patients reported significantly more fatigue compared to non-anaemic patients. Decreased haemoglobin and higher NYHA class explained 30% of the variance in General Fatigue. Perceived fatigue was also inversely related to global health and quality of life. CONCLUSION Our findings suggest that the subjective experience of fatigue in patients with CHF is associated with low haemoglobin concentration and reduced functional status after controlling for age and sex.
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Affiliation(s)
- Kristin Falk
- Institute of Nursing, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, S-405 30 Göteborg, Sweden.
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Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, Asensio Lafuente E, Torres Villanueva F, Rebollar González V, Narváez David R, Dorantes García J. Body composition and echocardiographic abnormalities associated to anemia and volume overload in heart failure patients. Clin Nutr 2006; 25:746-57. [PMID: 16698139 DOI: 10.1016/j.clnu.2006.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 01/12/2006] [Accepted: 01/13/2006] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart failure (HF) patients with hemodilutional anemia had a worse prognosis than those with true anemia. Volume overload (VO) in anemic patients must be identified in order to select the best treatment. METHOD We assessed the prevalence of anemia and VO in systolic and diastolic HF patients, and its effects on clinical status, body composition, and quality of life (QOL). Anemia was defined according to the OMS criteria and VO was assessed by bioelectrical impedance analysis (BIA). Echocardiography variables were also obtained. RESULTS We studied 132 HF patients, 59.1% with systolic and 40.9% with diastolic HF. Anemia was present in 29.5% patients with systolic and 24.1% with diastolic HF (P=0.7). Anemic patients in the systolic HF group tend to be worse functional class than the non-anemic subjects; moreover, in both groups of cardiac dysfunction, the anemic patients had less grip strength, lower body mass index (BMI) and waist and hip circumferences, and a higher percentage of extracellular water (ECW), a higher proportion of patients with total serum cholesterol concentration below the 25th percentile, and a lower serum albumin. When patients were divided in 4 subgroups according to the presence of anemia and/or VO, we observed that VO affected the body composition not only through lower BMI, and waist and hip circumferences but also through a lower phase angle. Systolic HF patients with anemia and VO had the highest dimension of left atrium and pulmonary artery pressure (PAP) levels. CONCLUSION Anemia is common in HF and its prevalence is similar in systolic and diastolic HF patients. Anemia was associated to VO, less grip strength and body composition abnormalities; however, VO was related to more severe body composition and echocardiographic abnormalities, as well as to an impairment of QOL. So that, it is important to differentiate between those who have anemia associated to VO and those who have true anemia.
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Affiliation(s)
- Eloisa Colín-Ramírez
- Heart Failure Clinic, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, México
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Silverberg DS, Wexler D, Iaina A, Schwartz D. The Interaction Between Heart Failure and Other Heart Diseases, Renal Failure, and Anemia. Semin Nephrol 2006; 26:296-306. [PMID: 16949468 DOI: 10.1016/j.semnephrol.2006.05.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anemia, defined as a hemoglobin level of less than 12 g/dL, often is seen in congestive heart failure (CHF). It is associated with an increased mortality and morbidity and increased hospitalizations. Compared with nonanemic patients the presence of anemia also is associated with worse cardiac clinical status, more severe systolic and diastolic dysfunction, a higher beta natriuretic peptide level, increased extracellular and plasma volume, a more rapid deterioration of renal function, a lower quality of life, and increased medical costs. The only way to determine if anemia is merely a marker for more severe CHF or actually is contributing to the worsening of the CHF is to correct the anemia and see if this favorably influences the CHF. In several controlled and uncontrolled studies, correction of the anemia with subcutaneous erythropoietin (EPO) or darbepoetin in conjunction with oral and intravenous iron has been associated with an improvement in clinical status, number of hospitalizations, cardiac and renal function, and quality of life. However, larger, randomized, double-blind, controlled studies still are needed to verify these initial observations. The effect of EPO may be related partly to its nonhematologic functions including neovascularization; prevention of apoptosis of endothelial, myocardial, cerebral, and renal cells; increase in endothelial progenitor cells; and anti-inflammatory and antioxidant effects. Anemia also may play a role in increasing cardiovascular morbidity in chronic kidney insufficiency, diabetes, renal transplantation, asymptomatic left ventricular dysfunction, left ventricular hypertrophy, acute coronary syndromes including myocardial infarction and chronic coronary heart disease, and in cardiac surgery. Again, controlled studies of correction of anemia are needed to assess its importance in these conditions. The anemia in CHF mainly is caused by a combination of renal failure and CHF-induced increased cytokine production, and these can both lead to reduced production of EPO, resistance of the bone marrow to EPO stimulation, and to cytokine-induced iron-deficiency anemia caused by reduced intestinal absorption of iron and reduced release of iron from iron stores. The use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers also may inhibit the bone marrow response to EPO. Hemodilution caused by CHF also may cause a low hemoglobin level. Renal failure, cardiac failure, and anemia therefore all interact to cause or worsen each other--the so-called cardio-renal-anemia syndrome. Adequate treatment of all 3 conditions will slow down the progression of both the CHF and the chronic kidney insufficiency.
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Affiliation(s)
- Donald S Silverberg
- Department of Nephrology, Department of Cardiology and Heart Failure Unit, Tel Aviv Medical Center, Tel Aviv, Israel.
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35
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Affiliation(s)
- Yi-Da Tang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
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Muñoz Gómez M, García Erce JA. Insuficiencia cardíaca severa y anemia. Rev Clin Esp 2006; 206:164; author reply 164-5. [PMID: 16597391 DOI: 10.1157/13086219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Sato S, Furuta K, Miyake T, Mishiro T, Kohge N, Akagi S, Uchida Y, Rumi MAK, Ishihara S, Adachi K, Kinoshita Y. Hemolytic anemia during 24 weeks of ribavirin and interferon-alpha2b combination therapy does not influence the cardiac function of patients with viral hepatitis C. J Clin Gastroenterol 2006; 40:88-9. [PMID: 16340643 DOI: 10.1097/01.mcg.0000190781.96021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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38
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Ralli S, Horwich TB, Fonarow GC. Relationship between anemia, cardiac troponin I, and B-type natriuretic peptide levels and mortality in patients with advanced heart failure. Am Heart J 2005; 150:1220-7. [PMID: 16338262 DOI: 10.1016/j.ahj.2005.01.049] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 01/10/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anemia has been associated with worse symptoms and increased mortality in patients with advanced HF. The association between anemia and biomarkers of increased HF risk is unknown. This study aimed to evaluate the relationship between hemoglobin (Hb), cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), and mortality in patients with advanced heart failure (HF). METHODS A cohort of 264 patients with advanced HF referred to a single university HF center was analyzed. Hb, cTnI, and BNP levels were drawn at time of initial evaluation. Patients were divided into groups based on the presence or absence of anemia, detectable cTnI (> or = 0.04 ng/mL), and elevated BNP (> or = 485 pg/mL). RESULTS Mean Hb was 13.0 and the values ranged from 7.7 to 17.9 g/dL. Anemic patients were more likely to have elevated BNP (65.7% vs 47.4%, P = .002). Cardiac troponin I levels were detectable in 50.9% and 46.8% of anemic and non-anemic patients, respectively (P = .3). Anemic patients were at 2.3-fold increased risk of mortality (P = .04). Low Hb, detectable cTnI, and elevated BNP remained independent predictors of mortality on multivariate analysis. Anemia in the setting of detectable cTnI, elevated BNP, or both, was associated with markedly increased mortality. CONCLUSIONS Anemia is associated with elevated BNP and increased mortality in HF. Furthermore, elevation of the cardiac biomarkers, BNP and cTnI, in patients with HF and anemia identifies patients at particularly high risk of future events.
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Affiliation(s)
- Sonia Ralli
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA 90095-1679, USA
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Abstract
Anaemia is common in patients with congestive heart failure (CHF). Its prevalence increases with disease severity as a consequence of renal insufficiency, cytokine production, blood loss, iron deficiency, malnutrition and/or plasma volume overload. Anaemia can contribute to worsening of CHF. There is a nonlinear relationship (U-shaped curve) between haemoglobin and survival. Prevalence of anaemia among elderly people with acute myocardial infarction is high and is associated with more frequent in-hospital events, including death. Anaemia is also associated with higher in-hospital mortality rate after coronary bypass surgery and with all-cause and cardiac mortality after percutaneous coronary interventions. Patients with anaemia and cardiovascular disease have a higher mortality rate after cardiac/noncardiac surgery as compared to those with anaemia but without cardiovascular disease or those with cardiovascular disease but without anaemia. However, not all authors confirmed these findings. Therefore, multicentre trials to clarify this issue are urgently needed. Pleiotropic effects of recombinant human erythropoietin include reduction of myocardial and cerebral infarct size without an increase in haematocrit, neovascularization as well as mobilization of endothelial progenitor cells.
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Affiliation(s)
- W H Hörl
- Department of Medicine, University of Vienna, Austria.
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40
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Cirillo M, De Santo LS, Pollastro RM, Romano G, Mastroianni C, Mastroiacono C, Maiello C, Amarelli C, Di Stazio E, Perna A, Anastasio P. Creatinine Clearance and Hemoglobin Concentration Before and After Heart Transplantation. Semin Nephrol 2005; 25:413-8. [PMID: 16298265 DOI: 10.1016/j.semnephrol.2005.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinical studies indicate that indices of glomerular filtration rate (GFR) as serum creatinine or creatinine clearance can predict the risk of death in congestive heart failure (CHF) and in heart transplantation. The study reports data on creatinine clearance before and after heart transplantation in 160 patients followed-up for 5 years at our Unit. Pre-transplant creatinine clearance averaged 83.5+/-32 mL/min x 1.73 m(2) and was not significantly associated with 5-year mortality. Creatinine clearance significantly decreased after heart transplantation with a linear trend up to 3 years for patients with complete follow-up. Data suggest that the relation between kidney function and mortality after heart transplantation is affected by several confounders with inclusion of cause of heart disease, co-morbidity, anemia, and post-transplant decrease in kidney function.
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Affiliation(s)
- Massimo Cirillo
- Departments of Nephrology and Heart Surgery, Second University of Naples, Naples, Italy.
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41
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Coats AJS. Top of the charts: download versus citations in the International Journal of Cardiology. Int J Cardiol 2005; 105:123-5. [PMID: 16214247 DOI: 10.1016/j.ijcard.2005.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Accepted: 08/28/2005] [Indexed: 11/21/2022]
Abstract
The medical literature is growing at an alarming rate. Research assessment exercises, research quality frameworks, league tables and the like have attempted to quantify the volume, quality and impact of research. Yet the established measures (such as citation rates) are being challenged by the sheer number of journals, variability in the "gold standard" of peer-review and the emergence of open-source or web-based journals. In the last few years, we have seen a growth in downloads to individual journal articles that now easily exceeds formal journal subscriptions. We have recorded the 10 top cited articles over a 12-month period and compared them to the 10 most popular articles being downloaded over the same time period. The citation-based listing included basic and applied, observational and interventional original research reports. For downloaded articles, which have shown a dramatic increase for the International Journal of Cardiology from 48,000 in 2002 to 120,000 in 2003 to 200,000 in 2004, the most popular articles over the same period are very different and are dominated by up-to-date reviews of either cutting-edge topics (such as the potential of stem cells) or of the management of rare or unusual conditions. There is no overlap between the two lists despite covering exactly the same 12-month period and using measures of peer esteem. Perhaps the time has come to look at the usage of articles rather than, or in addition to, their referencing.
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Abstract
BACKGROUND In patients with chronic kidney disease, the adverse cardiovascular effects of anemia have been well established. New data are emerging to suggest anemia may represent an important treatable cause of cardiac morbidity and mortality in patients with heart failure. To improve the understanding of the problem of anemia in heart failure, it is important to assess the factors that influence the prevalence of anemia and to assess the consistency of the association of anemia and mortality in various populations of patients with heart failure. METHODS A systematic review of the literature was conducted by performing detailed searches of MEDLINE and EMBASE, searching the bibliographies of the articles retrieved during the database search, and conferring with heart-failure experts involved in clinical trials. Twenty-eight publications from 26 studies that evaluated anemia prevalence with or without effects on mortality in patients with heart failure were identified. The definition of anemia used in each study was tabulated along with pertinent patient characteristics, the prevalence of anemia, and the association between anemia and mortality. RESULTS Anemia is common among patients with heart failure. The prevalence of anemia increases with increasing severity of heart failure, declining renal function, and increasing age. Anemia is consistently associated with poorer survival in all patient populations, but there are substantial differences in the patient populations and definition of anemia. CONCLUSIONS To clarify the prognostic relationship of anemia in patients with heart failure, a standard definition of anemia should be adopted accounting for the menopausal status of women. Age, severity of heart failure, evaluation of kidney function, important comorbidities, and use of angiotensin-converting-enzyme inhibitors should be included, and correctable causes of anemia should be excluded. Inclusion of these factors should allow better definition of the relationship between anemia and prognosis in patients with heart failure.
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Affiliation(s)
- Joann Lindenfeld
- Cardiac Transplantation Program and the Center for Women's Health Research, University of Colorado Health Sciences Center, Denver, Colo 80262, USA.
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Iaina A, Silverberg DS, Wexler D. Therapy Insight: congestive heart failure, chronic kidney disease and anemia, the cardio–renal–anemia syndrome. ACTA ACUST UNITED AC 2005; 2:95-100. [PMID: 16265380 DOI: 10.1038/ncpcardio0094] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 12/14/2004] [Indexed: 11/08/2022]
Abstract
Congestive heart failure (CHF) and chronic kidney disease (CKD) often progress to end stage even with optimum medical therapy. One factor that is common to both conditions is anemia, which is present in about a third of CHF patients. CHF can cause or worsen both anemia and CKD, and CKD can cause or worsen both anemia and CHF. Thus, a vicious circle exists between these three conditions, with each causing or worsening the other. We have called this condition the cardio-renal-anemia syndrome. Anemia in CHF is associated with increased mortality and hospitalization, reduced cardiac function and evidence of more severe CHF and CKD than in nonanemic patients. Intervention studies in anemic CHF patients have shown that optimum medical treatment of CHF and the correction of the associated anemia with subcutaneous erythropoietin and oral iron or intravenous iron sucrose can improve cardiac function, patients' functional status, renal function and quality of life, and reduce the frequency of hospitalization and the dose of diuretics required.
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Affiliation(s)
- Adrian Iaina
- Department of Nephrology, Tel Aviv Medical Center, Tel Aviv, Israel.
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García Erce JA, Muñoz Gómez M. Corrección de la anemia en el tratamiento de la insuficiencia cardíaca grave. Med Clin (Barc) 2005; 124:157-8; author reply 158. [PMID: 15713249 DOI: 10.1157/13071014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Silverberg DS, Wexler D, Blum M, Iaina A, Sheps D, Keren G, Scherhag A, Schwartz D. Effects of Treatment with Epoetin Beta on Outcomes in Patients with Anaemia and Chronic Heart Failure. Kidney Blood Press Res 2005; 28:41-7. [PMID: 15489560 DOI: 10.1159/000081621] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2004] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Anaemia is frequently found in patients with chronic heart failure (CHF) and has been associated with an increase in mortality and morbidity, impaired cardiac and renal function and a reduced quality of life (QoL) compared with non-anaemic CHF patients. Correction of anaemia with recombinant human erythropoietin (epoetin) has been associated with an improvement in CHF in both controlled and uncontrolled studies. The present study describes our findings in a series of 78 consecutive patients with symptomatic CHF and anaemia (haemoglobin (Hb) level <12.0 g/dl) treated with epoetin beta and, if necessary, intravenous iron sucrose. Over a mean observation period of 20.7 +/- 12.1 months, mean Hb levels increased from 10.2 +/- 1.1 to 13.5 +/- 1.2 g/dl, p < 0.01. New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) were significantly improved and the number of hospitalizations was significantly reduced with the period before treatment (all p < 0.01). Serum creatinine and creatinine clearance (CCr) were 2.2 +/- 0.9 mg/dl and 32.5 +/- 26.5 ml/min, respectively, at baseline, and remained stable over the observation period. Interestingly, >90% of the patients had concomitant mild-to-moderate chronic kidney disease at baseline and study end (CKD), as defined by the accepted diagnostic criterion of a CCr <60 ml/min. CONCLUSIONS The correction of the anaemia with epoetin beta together with initial intravenous iron supplementation, resulted in significant improvements in NYHA class and cardiac function, and a reduction in hospitalization rate. Moreover, renal function was maintained stable in most patients.
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Affiliation(s)
- Donald S Silverberg
- Department of Nephrology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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46
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Abstract
Over the past few years, anemia has emerged as a powerful independent predictor of adverse outcomes in chronic heart failure (CHF). It affects up to 50% of patients with CHF, depending on the definition of anemia used and on the population studied. Even small reductions in hemoglobin are associated with worse outcome. However, the causes of anemia in CHF remain unclear, although impairment of renal function and inflammatory cytokines are proposed mechanisms. Both may act through impairment of the synthesis or action of erythropoietin. Preliminary studies have demonstrated improvement in symptoms, exercise tolerance, quality of life, and reductions in hospitalizations when patients with severe CHF were treated with erythropoietin. The benefits and the potential risks of such therapies will be further addressed in upcoming larger randomized trials. The recent interest in anemia reflects a new perspective in heart failure therapy, focusing on non-cardiovascular comorbidities.
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Affiliation(s)
- Eileen O'Meara
- Department of Cardiology, Western Infirmary, Glasgow G11 6NT, UK
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