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Rasooly D, Moonesinghe R, Littrell K, Hull L, Khoury MJ. Association Between a First-Degree Family History and Self-Reported Personal History of Obesity, Diabetes, and Heart and Blood Conditions: Results From the All of Us Research Program. J Am Heart Assoc 2023; 12:e030779. [PMID: 37947093 PMCID: PMC10727309 DOI: 10.1161/jaha.123.030779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Family history reflects the complex interplay of genetic susceptibility and shared environmental exposures and is an important risk factor for obesity, diabetes, and heart and blood conditions (ODHB). However, the overlap in family history associations between various ODHBs has not been quantified. METHODS AND RESULTS We assessed the association between a self-reported family history of ODHBs and their risk in the adult population (age ≥20 years) of the AoU (All of Us) Research Program, a longitudinal cohort study of diverse participants across the United States. We conducted a family history-wide association study to systematically assess the association of a first-degree family history of 15 ODHBs in AoU. We performed stratified analyses based on racial and ethnic categories, education, household income and gender minority status, and quantified associations by type of affected relatives. Of 125 430 participants, 76.8% reported a first-degree family history of any ODHB, most commonly hypertension (n=64 982, 51.8%), high cholesterol (49 753, 39.7%), and heart attack (29 618, 23.6%). We use the FamWAS method to estimate 225 familial associations among 15 ODHBs. The results include overlapping associations between family history of different types of cardiometabolic conditions (such as type 2 diabetes and coronary artery disease), and their risk factors (obesity, hypertension), where adults with a family history of 1 ODHB exhibited 1.1 to 5.6 times (1.5, on average) the odds of having a different ODHB. CONCLUSIONS Our findings inform the utility of family history data as a risk assessment and screening tool for the prevention of ODHBs and to provide additional insights into shared risk factors and pathogenic mechanisms.
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Affiliation(s)
- Danielle Rasooly
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Ramal Moonesinghe
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kevin Littrell
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Muin J. Khoury
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
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Scicchitano P, Iacoviello M, Massari A, De Palo M, Potenza A, Landriscina R, Abruzzese S, Tangorra M, Guida P, Ciccone MM, Caldarola P, Massari F. Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role. Biomedicines 2023; 11:biomedicines11030972. [PMID: 36979951 PMCID: PMC10046168 DOI: 10.3390/biomedicines11030972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this study was to evaluate the relationship between anaemia and biomarkers of central/peripheral congestion in heart failure (HF) and the impact on mortality. We retrospectively evaluated 434 acute/chronic HF (AHF/CHF) patients. Anaemia was defined as haemoglobin levels <12 g/dL (women) or <13 g/dL (men). The brain natriuretic peptide (BNP) and hydration index (HI) were measured. The endpoint of the study was all-cause mortality. Anaemia occurred in 59% of patients with AHF and in 35% with CHF (p < 0.001) and showed a significant correlation with the NYHA functional class and renal function. BNP and HI were significantly higher in patients with anaemia than in those without anaemia. Independent predictors of anaemia included BNP, estimated creatinine clearance (eCrCL), and HI. The all-cause mortality rate was 21%, which was significantly higher in patients with anaemia than in those without anaemia (30% vs. 14%, p < 0.001; hazard ratio: 2.6). At multivariate Cox regression analysis, BNP, eCrCL, and HI were independent predictors for mortality (Hazard ratios: 1.0002, 0.97, and 1.05, respectively), while anaemia was not. Anaemia correlates with HF status, functional class, renal function, BNP, and HI. Anaemia was not an independent predictor for mortality, acting as a disease severity marker in congestive patients rather than as a predictor of death.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | | | - Micaela De Palo
- Cardiac Surgery Unit, Policlinic University Hospital, 70124 Bari, Italy
| | - Angela Potenza
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | | | - Silvia Abruzzese
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Maria Tangorra
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Piero Guida
- Ospedale Generale Regionale "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Marco Matteo Ciccone
- Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Francesco Massari
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
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Cireli E, Mertoğlu A. The impact of anemia on the mortality of COPD patients hospitalized for acute exacerbation resulting in respiratory failure. Monaldi Arch Chest Dis 2022; 93. [PMID: 36039851 DOI: 10.4081/monaldi.2022.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Anemia increases mortality in patients with chronic obstructive pulmonary disease (COPD), but its effects on mortality and survival time for different levels of airflow limitation severity are unclear. Our goal was to investigate the effects of anemia on survival time and mortality in COPD patients with varying degrees of airflow limitation. We looked at 300 consecutive COPD patients in the past. Their demographic information, Charlson comorbidity index, previous early (30 days) and late (>30 days) hospitalizations, blood counts, and post-bronchodilator spirometric values were all recorded. They were contacted by phone to check on their vital status, and their mortality rates were calculated. Anemic patients had a mean overall survival time of 31.9 2.8 months and normal patients had a mean overall survival time of 41.7 2.1 months (p=0.001). Their 1-year and 2-year mortality rates are higher. Age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations all had an impact on mortality. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients had a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 had shorter survival times. Anemic COPD patients have higher 1-year and 2-year mortality rates. Mortality is affected by age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients have a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 have shorter survival times.
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Abstract
PURPOSE OF REVIEW Exercise causes various dynamic changes in all body parts either in healthy subject or in heart failure (HF) patients. The present review of current knowledge about HF patients with reduced ejection fraction focuses on dynamic changes along a "metabo-hemodynamic" perspective. RECENT FINDINGS Studies on the dynamic changes occurring during exercise span many years. Thanks to the availability of advanced methods, it is nowadays possible to properly characterize respiratory, hemodynamic, and muscular function adjustments and their mismatch with the pulmonary and systemic circulations. Exercise is a dynamic event that involves several body functions. In HF patients, it is important to know at what level the limitation takes place in order to better manage these patients and to optimize therapeutic strategies.
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Vergaro G, Emdin M, Lupón J. How a large registry can explain pathophysiology: The case of anemia in the heart failure syndromes. Int J Cardiol 2020; 298:72-73. [PMID: 31611082 DOI: 10.1016/j.ijcard.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Heart Failure Clinic, Health Sciences Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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García-Bello JA, Ortiz-Flores J, Torres de la Riva FE, Mendoza-Moreno GK, Gómez-Tenorio C. Anemia and hypoalbuminemia as risk factors for left ventricular diastolic dysfunction in children with chronic kidney disease on peritoneal dialysis. Nefrologia 2019; 38:414-419. [PMID: 30032857 DOI: 10.1016/j.nefro.2017.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/27/2017] [Accepted: 11/28/2017] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Left ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/e' ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVRFs) and E/e' in children with automated peritoneal dialysis (APD) has not been widely studied. OBJECTIVE To measure the association between CVRFs and E/e' in children with CKD on APD. METHODS Cross-sectional, prolective, observational, analytical study of children aged 6-16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, hemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/e' ratio was measured and considered to have increased when it was higher than 15. RESULTS Twenty-nine children were studied, (19 females). Age was 14.0±2.5 years, and 16.9±11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/e'. E/e' correlated significantly with hemoglobin (r=-0.53, P=.003). Hemoglobin and albumin were significantly lower (9.72±1.9 vs. 12.2±1.8; P=.004 and 3.6±0.5 vs. 4.0±0.3; P=.035) and the proportion of patients with anemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; P=.019 and 61.9% vs. 12.5%; P=.035) in patients with increased E/e'. Hemoglobin was the only independent predictor of E/e' (β=-0.66; P=.020) and patients with anemia were 10 times more likely to have increased E/e' (95% CI 1.5-65.6, P=.016). CONCLUSIONS 75% of the children had increased E/e'. Anemia and hypoalbuminemia were significantly related with an increased E/e'.
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Affiliation(s)
- J Antonio García-Bello
- División de Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Gineco-obstetricia n.° 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - Joel Ortiz-Flores
- Servicio de Nefrología Pediátrica, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Francisco E Torres de la Riva
- Servicio de Cardiología Pediátrica, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - G Karina Mendoza-Moreno
- Servicio de Nefrología Pediátrica, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Circe Gómez-Tenorio
- Servicio de Nefrología Pediátrica, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Negi PC, Dev M, Paul P, Pal Singh D, Rathoure S, Kumar R, Dhiman A, Kandoria A, Ganju N, Sharma R, Bhardwaj R, Merwaha R, Asotra S, Mahajan K, Sondhi S, Rao S. Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry. Indian Heart J 2018; 70 Suppl 3:S182-S188. [PMID: 30595254 PMCID: PMC6310070 DOI: 10.1016/j.ihj.2018.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF). METHODS Serum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables. RESULTS Iron deficiency and anemia were prevalent in 58.8% (52.2%-65.1%) and 35.8% (29.8%-42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9-6.5)], history of bleeding [OR 11.7 (95% CI 1.4-101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4-4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40-6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97-0.99)], history of bleeding [OR 13.0 (95% CI 2.3-70.9)], and female gender [OR 2.9 (95% CI 1.5-5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70-0.96) and transferrin saturation (OR 0.98 (95% CI 0.96-0.99)] had a significant inverse association with symptoms of advanced heart failure. CONCLUSION Iron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure.
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Xiong W, Xu M, Pudasaini B, Guo X, Liu J. The influence of anemia on one-year exacerbation rate of patients with COPD-PH. BMC Pulm Med 2018; 18:143. [PMID: 30139350 PMCID: PMC6107965 DOI: 10.1186/s12890-018-0693-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anemia is prevalent not only in COPD but also in pulmonary hypertension. We postulated that anemia may have certain prognostic value in COPD concomitant with PH due to COPD (COPD-PH). METHODS We performed a 12-month prospective investigation to follow up COPD patients with or without PH assessed by right heart catheterization. Eligible patients were enrolled, stratified into COPD-PH-anemia group (n = 40), COPD-PH group (n = 42), COPD-anemia group (n = 48), and COPD group(n = 50), and then followed up for 12 months. RESULTS After the follow-up, for both of the actual variation value and variation rate, the increase of NT-pro BNP (P<0.001; P = 0.03) and CAT score (P = 0.001; 0.002), as well as the decrease of PaO2 (P = 0.03; 0.086) and Peak VO2 (P = 0.021; 0.009) in COPD-PH-anemia group were highest among four groups. The cumulative one-year survival rates were similar among four groups (P = 0.434). The cumulative exacerbation-free rate was lowest in COPD-PH-anemia group among four groups (P<0.001). Hemoglobin was an independent promoting factor for the probability of hospitalization due to exacerbation ≧ 1/year in patients with COPD-PH-anemia [HR 3.121(2.325-5.981); P<0.001]. CONCLUSIONS Anemia is a promoting factor for the worsening of exercise capacity, deterioration of hypoxemia, declining of life quality, and aggravation of exacerbations in patients with COPD-PH-anemia, by contrast with COPD-PH, COPD-anemia, and COPD.
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Affiliation(s)
- Wei Xiong
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.,Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mei Xu
- Department of Pediatrics, Dinghai Community Health Service Center, Tongji University School of Medicine, Shanghai, China;Department of Pediatrics, Kongjiang Hospital, Yangpu District, Shanghai, China
| | - Bigyan Pudasaini
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuejun Guo
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China
| | - Jinming Liu
- Department of Cardiopulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Son YJ, Kim BH. Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Eur J Cardiovasc Nurs 2017; 16:687-695. [DOI: 10.1177/1474515117710154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. Aims: We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Methods: This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. Results: The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% ( p = 0.001) and 55.1% vs. 34% ( p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19–29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22–4.60) in patients with heart failure. Conclusion: It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Bo Hwan Kim
- College of Nursing, Gachon University, Incheon, Korea
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Lee SL, Daimon M, Nakao T, Singer DE, Shinozaki T, Kawata T, Kimura K, Hirokawa M, Kato TS, Mizuno Y, Watanabe M, Yatomi Y, Yamazaki T, Komuro I. Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors? J Cardiol 2016; 68:275-81. [DOI: 10.1016/j.jjcc.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
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Díez-López C, Lupón J, de Antonio M, Zamora E, Domingo M, Santesmases J, Troya MI, Boldó M, Bayes-Genis A. Hemoglobin Kinetics and Long-term Prognosis in Heart Failure. ACTA ACUST UNITED AC 2016; 69:820-6. [PMID: 27318441 DOI: 10.1016/j.rec.2016.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES The influence of hemoglobin kinetics on outcomes in heart failure has been incompletely established. METHODS Hemoglobin was determined at the first visit and at 6 months. Anemia was defined according to World Health Organization criteria (hemoglobin < 13g/dL for men and hemoglobin < 12g/dL for women). Patients were classified relative to their hemoglobin values as nonanemic (both measurements normal), transiently anemic (anemic at the first visit but not at 6 months), newly anemic (nonanemic initially but anemic at 6 months), or permanently anemic (anemic in both measurements). RESULTS A total of 1173 consecutive patients (71.9% men, mean age 66.8±12.2 years) were included in the study. In all, 476 patients (40.6%) were considered nonanemic, 170 (14.5%) had transient anemia, 147 (12.5%) developed new-onset anemia, and 380 (32.4%) were persistently anemic. During a follow-up of 3.7±2.8 years after the 6-month visit, 494 patients died. On comprehensive multivariable analyses, anemia (P < .001) and the type of anemia (P < .001) remained as independent predictors of all-cause mortality. Compared with patients without anemia, patients with persistent anemia (hazard ratio [HR] = 1.62; 95% confidence interval [95%CI], 1.30-2.03; P < .001) and new-onset anemia (HR = 1.39; 95%CI, 1.04-1.87, P = .03) had higher mortality, and even transient anemia showed a similar trend, although without reaching statistical significance (HR = 1.31; 95%CI, 0.97-1.77, P = .075). CONCLUSIONS Anemia, especially persistent and of new-onset, and to a lesser degree, transient anemia, is deleterious in heart failure.
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Affiliation(s)
- Carles Díez-López
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Santesmases
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Isabel Troya
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Boldó
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Hirokawa M, Daimon M, Lee SL, Nakao T, Kawata T, Kimura K, Kato TS, Mizuno Y, Watanabe M, Yatomi Y, Yamazaki T, Komuro I. Early menopause does not influence left ventricular diastolic dysfunction: A clinical observational study in healthy subjects. J Cardiol 2016; 68:548-553. [PMID: 26778586 DOI: 10.1016/j.jjcc.2015.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of left ventricular diastolic dysfunction (LVDD) sharply increases in women after their 50s and may contribute to the high prevalence of diastolic heart failure in elderly women. A decrease in estrogen levels after menopause is postulated to be one of the mechanisms responsible for this phenomenon. However, there is a paucity of data on the relationship between the timing of menopause and the progression of LVDD in the clinical setting; thus, we investigated this relationship in healthy postmenopausal women. METHODS We enrolled 115 women and divided them into two groups according to median menopause age: 61 who experienced menopause at ≤50 years (early menopause group), and 54 who experienced menopause at >50 years (late menopause group). We compared the echocardiographic and clinical characteristics between the two groups. RESULTS There were no significant differences in LV diastolic parameters (mitral E/A, p=0.561; e', p=0.052; E/e', p=0.081; DCT, p=0.082; prevalence of LVDD class, p=0.801), as well as other echocardiographic parameters and clinical characteristics between the two groups. Multivariate linear regression analysis showed that the independent determinants of LVDD were age and body mass index, but not the timing of menopause. CONCLUSIONS Early menopause did not influence the progression of LVDD in postmenopausal women. The sharp progression of LVDD in elderly women is complex and probably influenced by multiple factors.
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Affiliation(s)
- Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan; Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan.
| | - Seitetsu L Lee
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoko Nakao
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Takayuki Kawata
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichi Kimura
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoko S Kato
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan; Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan; Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Tsutomu Yamazaki
- Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Robles Perez-Monteoliva NR, Macías Núñez JF, Herrera Pérez de Villar J. Uso de agentes estimuladores de la eritropoyesis en pacientes con insuficiencia cardiaca congestiva. Med Clin (Barc) 2014; 142:215-8. [DOI: 10.1016/j.medcli.2013.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 11/25/2022]
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Abstract
Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.
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Affiliation(s)
- Ravish Shah
- Division of Nephrology, The Ohio State University, Columbus, Ohio 43210, USA.
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17
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Abstract
Traditionally, erythropoietin (EPO) is described as a hematopoietic cytokine, regulating proliferation and differentiation and survival of the erythroid progenitors. The recent finding of new sites of EPO production and the wide spread distribution of EPO receptors (EPO-R) on endothelial cells, cardiomyocytes, renal cells as well as the central and peripheral nervous system raised the possibility that EPO may exert pleiotropic actions on several targets. Indeed studies (mainly preclinical) have documented protective, non-hematopoietic, abilities of EPO in a variety of tissue. However, the data obtained from clinical studies are more skeptical about these properties. This article provides a comprehensive overview of EPO and its derivatives.
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Affiliation(s)
- Mariusz Kowalczyk
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
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18
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Treatment of anemia in heart failure: potential risks and benefits of intravenous iron therapy in cardiovascular disease. Cardiol Rev 2011; 18:240-50. [PMID: 20699672 DOI: 10.1097/crd.0b013e3181e71150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Iron-deficiency anemia is common in patients with heart failure (HF), but the optimum diagnostic tests to detect iron deficiency and the treatment options to replete iron have not been fully characterized. Recent studies in patients with HF indicate that intravenous iron can rapidly replenish iron stores in patients having iron-deficiency anemia, with resultant increased hemoglobin levels and improved functional capacity. Preliminary data from a subgroup analysis also suggest that supplemental intravenous iron therapy can improve functional capacity even in those subjects without anemia. The mechanisms responsible for this observation are not fully characterized, but may be related to beneficial effects of iron supplementation on mitochondrial respiration in skeletal muscle. The long-term safety of using intravenous iron supplementation in HF populations is not known. Iron is a known pro-oxidant factor that can inhibit nitric oxide signaling and irreversibly injury cells. Increased iron stores are associated with vascular endothelial dysfunction and increased risk of coronary heart disease events. Additional clinical trials are needed to more fully characterize the therapeutic potential and safety of intravenous iron in HF patients.
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Geisler BP. Treating anemia in heart failure patients: a review of erythropoiesis-stimulating agents. Expert Opin Biol Ther 2010; 10:1209-16. [PMID: 20557272 DOI: 10.1517/14712598.2010.500282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Prevalence of chronic heart failure (CHF) is increasing, and despite improvements in the past decade the prognosis in terms of mortality and health-related quality of life remains poor. Anemia is often found concomitantly in CHF patients. AREAS COVERED IN THIS REVIEW Erythropoiesis-stimulating agents (ESAs) are a new treatment option for these anemic CHF patients, promising to decrease mortality and hospitalizations, and increase health-related quality of life. WHAT THE READER WILL GAIN CHF epidemiology is briefly discussed. Currently available clinical efficacy and safety data are critically appraised. Health care utilization by CHF patients, particularly hospitalizations, are reviewed in order predict cost-effectiveness of ESAs. TAKE HOME MESSAGES The efficacy for the most pertinent endpoints has not been proven by a pivotal trial or a meta-analysis free of bias, and there might be increased cardiovascular events and cancer incidence rates above a currently unknown target value or with multiple doses. However, subgroups should be identified in which ESAs might prove to be more efficacious and as safe as usual care and either cost-saving or cost-effective. Nevertheless, depending on the subgroup, the budget effect for payors might be dramatic due to the large number of CHF patients.
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Affiliation(s)
- Benjamin P Geisler
- Massachusetts General Hospital, Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA.
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20
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Correcting Anemia in Heart Failure: The Efficacy and Safety of Erythropoiesis-Stimulating Agents. J Card Fail 2010; 16:649-58. [DOI: 10.1016/j.cardfail.2010.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/15/2010] [Accepted: 03/31/2010] [Indexed: 11/22/2022]
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Sandhu A, Soman S, Hudson M, Besarab A. Managing anemia in patients with chronic heart failure: what do we know? Vasc Health Risk Manag 2010; 6:237-52. [PMID: 20407631 PMCID: PMC2856579 DOI: 10.2147/vhrm.s4619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Indexed: 01/06/2023] Open
Abstract
Anemia is common in patients with chronic heart failure (HF) with an incidence ranging from 4% to 55% depending on the studied population. Several studies have highlighted that the prevalence of anemia increases with worsening heart failure as reflected by New York Heart Association classification. Additionally, several epidemiological studies have highlighted its role as a prognostic marker, linking it to worse outcomes including; malnutrition, increased hospitalizations, refractory heart failure and death. The pathophysiology of anemia is multifactorial and related to various factors including; hemodilution, iron losses from anti-platelet drugs, activation of the inflammatory cascade, urinary losses of erythropoietin and associated renal insufficiency. There are a host of epidemiological studies examining HF outcomes and anemia, but only a few randomized trials addressing this issue. The purpose of this article is to review the literature that examines the interrelationship of anemia and congestive HF, analyzing its etiology, impact on outcomes and also the role of associated kidney disease as well as cardiorenal syndrome both as a marker of morbidity and mortality.
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Affiliation(s)
- Ankur Sandhu
- Division of Nephrology, Henry Ford Health System, Detroit, Michigan 48202, USA
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23
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Adams KF, Patterson JH, Oren RM, Mehra MR, O'Connor CM, Piña IL, Miller AB, Chiong JR, Dunlap SH, Cotts WG, Felker GM, Schocken DD, Schwartz TA, Ghali JK. Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry. Am Heart J 2009; 157:926-32. [PMID: 19376323 DOI: 10.1016/j.ahj.2009.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 01/11/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although a potentially important pathophysiologic factor in heart failure, the prevalence and predictors of anemia have not been well studied in unselected patients with heart failure. METHODS The Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry prospectively studied the prevalence of anemia and the relationship of hemoglobin to health-related quality of life and outcomes among patients with heart failure. A random selection algorithm was used to reduce bias during enrollment of patients seen in specialty clinics or clinics of community cardiologists with experience in heart failure. In this initial report, data on prevalence and correlates of anemia were analyzed in 1,076 of the 1,082 registry patients who had clinical characteristics and hemoglobin determined by finger-stick at baseline. RESULTS Overall (n = 1,082), the registry patients were 41% female and 73% white with a mean age (+/-SD) of 64 +/- 14 years (68 +/- 13 years in community and 57 +/- 14 years in specialty sites, P < .001). Among the 1,076 patients in the prevalence analysis, mean hemoglobin was 13.3 +/- 2.1 g/dL (median 13.2 g/dL); and anemia (defined by World Health Organization criteria) was present in 34%. Age identified patients at risk for anemia, with 40% of patients >70 years affected. CONCLUSIONS Initial results from the STAMINA-HFP Registry suggest that anemia is a common comorbidity in unselected outpatients with heart failure. Given the strong association of anemia with adverse outcomes in heart failure, this study supports further investigation concerning the importance of anemia as a therapeutic target in this condition.
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Affiliation(s)
- Kirkwood F Adams
- Department of Medicine and Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27514, USA.
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He SW, Wang LX. The impact of anemia on the prognosis of chronic heart failure: a meta-analysis and systemic review. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2009; 15:123-30. [PMID: 19522961 DOI: 10.1111/j.1751-7133.2008.00030.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the impact of anemia on the clinical outcomes of chronic heart failure (CHF) by a meta-analysis and systemic review of published literatures. Twenty published English-language articles were selected from Medline, PubMed, and ISI Database. Clinical data were extracted, pooled, and analyzed with a fixed- or random-effects model. A total of 97,699 patients with CHF were identified from the published studies. Meta-analysis of these studies indicated that anemia is associated with a higher risk for death (relative risk [RR], 1.66; P<.0001). In addition, anemic patients had more advanced New York Heart Association class (III or IV; RR, 1.35; P<.0001) and lower left ventricular ejection fraction (weight mean difference, -0.53; P<.0001) than nonanemic patients. Systemic review also revealed that the severity of anemia is closely related to the rate of mortality and hospitalization for heart failure. Anemia is associated with an increased risk of mortality and rate of hospitalization for heart failure. Anemia is an independent risk factor for adverse outcomes in patients with CHF.
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Affiliation(s)
- Sheng-Wen He
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales 2678, Australia
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25
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Hamaguchi S, Tsuchihashi-Makaya M, Kinugawa S, Yokota T, Takeshita A, Yokoshiki H, Tsutsui H, The JCARE-CARD Investigators. Anemia is an Independent Predictor of Long-Term Adverse Outcomes in Patients Hospitalized With Heart Failure in Japan A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2009; 73:1901-8. [DOI: 10.1253/circj.cj-09-0184] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sanae Hamaguchi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Miyuki Tsuchihashi-Makaya
- Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery? Ann Thorac Surg 2008; 86:1415-23. [DOI: 10.1016/j.athoracsur.2008.07.088] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/25/2008] [Accepted: 07/28/2008] [Indexed: 11/24/2022]
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27
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Prevalence and determinants of anemia in adults with complex congenital heart disease and ventricular dysfunction (subaortic right ventricle and single ventricle physiology). Am J Cardiol 2008; 102:625-8. [PMID: 18721525 DOI: 10.1016/j.amjcard.2008.04.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 04/04/2008] [Accepted: 04/04/2008] [Indexed: 10/21/2022]
Abstract
Anemia is well recognized as a marker of poor prognosis in patients with acquired heart disease and heart failure. Adults with complex congenital heart disease and ventricular dysfunction (subaortic right ventricle or single-ventricle physiology) represent a different population, because they are typically much younger and have less co-morbidity compared with patients with acquired forms of heart disease. The purpose of this study was to evaluate the prevalence and determinants of anemia in this population. Baseline hemoglobin levels were recorded at the time of the initial clinic visit, and final hemoglobin levels were those recorded before death or transplantation or at study completion. Anemia was defined as hemoglobin <135 g/L in men and <120 g/L in women. One hundred sixty-seven patients (100 men, mean age 34 +/- 8 years, mean ejection fraction 35 +/- 9%) were included, 66 with atrial switch operations, 42 with congenitally corrected transposition of the great arteries, and 59 with Fontan physiology. The mean hemoglobin level at baseline was 149 +/- 22 g/L and at follow-up was 139 +/- 29 g/L. The overall prevalence of anemia was 29% at completion. Hyponatremia, decreased renal function, and the use of warfarin were independent predictors of anemia. In conclusion, anemia is common in patients with complex congenital heart disease and ventricular dysfunction, in particular those with Fontan physiology.
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Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, van der Meer P. Anemia and Mortality in Heart Failure Patients. J Am Coll Cardiol 2008; 52:818-27. [PMID: 18755344 DOI: 10.1016/j.jacc.2008.04.061] [Citation(s) in RCA: 536] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/23/2008] [Accepted: 04/28/2008] [Indexed: 11/26/2022]
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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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Approaches to the treatment of anaemia in patients with chronic heart failure. Heart Fail Rev 2008; 13:431-8. [DOI: 10.1007/s10741-008-9085-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 01/08/2008] [Indexed: 11/29/2022]
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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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Palazzuoli A, Gallotta M, Iovine F, Nuti R, Silverberg DS. Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndrome. Int J Clin Pract 2008; 62:281-6. [PMID: 18081797 DOI: 10.1111/j.1742-1241.2007.01650.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although many studies have found a high prevalence of anaemia in patients with congestive heart failure (CHF), few have carefully examined the relationship between the CHF and the prevalence of anaemia and chronic renal insufficiency (CRI). Patients with advanced renal failure, significant anaemia, diffuse atherosclerosis, respiratory disease and more elderly patients have been systematically excluded from the great majority of the randomised clinical trials. DISCUSSION Both anaemia and renal insufficiency are very common associated diseases associated with increased mortality, morbidity and rate of hospitalisation in CHF patients. Impaired renal function is associated with adverse outcomes because it represents a marker of coexistent disease and more diffuse atherosclerosis. In patients with CHF, progressive renal dysfunction leads to a decrease in erythropoietin (EPO) levels with reduced erythrocyte production from bone marrow. This may explain the common association between CHF, anaemia and CRI in clinical practice. The normalisation of haemoglobin concentration by EPO in patients with CHF and CRI results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. CONCLUSION In this review, we describe the mechanisms linking anaemic status, CRI and CHF, the prognostic relevance of each disease, treatment implications, and potential benefit of EPO administration.
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Affiliation(s)
- A Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Section of Cardiology, Le Scotte Hospital, Siena, Italy.
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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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Baggish AL, van Kimmenade R, Bayes-Genis A, Davis M, Lainchbury JG, Frampton C, Pinto Y, Richards MA, Januzzi JL. Hemoglobin and N-terminal pro-brain natriuretic peptide: Independent and synergistic predictors of mortality in patients with acute heart failure. Clin Chim Acta 2007; 381:145-50. [PMID: 17445789 DOI: 10.1016/j.cca.2007.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 03/01/2007] [Accepted: 03/01/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemoglobin and amino-terminal pro-brain natriuretic peptide (NT-proBNP) are both independent predictors of mortality in patients with chronic HF. Their combined predictive power for mortality in the setting of acute HF is uncertain. METHODS In an international prospective cohort design, we evaluated the relationships between hemoglobin, NT-proBNP, and 60-day mortality in 690 patients with acute HF. RESULTS The median hemoglobin for the entire cohort was 13.0 g/dL (interquartile range 11.6-14.3). The WHO criterion for anemia was met by 44% (n=305). The 60-day mortality rate for anemic patients was 16.4% vs. 8.8% in non-anemic patients (p<0.001). Anemia was an independent predictor of short-term mortality (OR=1.72, 95% CI=1.05-2.80, p=0.03), as was a NT-proBNP concentration >5180 pg/mL (OR=2.32, 95% CI=1.36-3.94 p=0.002). Consideration of four risk groups: not anemic/low NT-proBNP (reference group, n=220), anemic/low NT-proBNP (n=152), not anemic/high NT-proBNP (n=165), and anemic/high NT-proBNP (n=153) revealed respective 60-day mortality rates of 5.0% (referent), 9.2% (OR=1.93, 95% CI=0.85-4.36; p=0.12), 13.9% (OR=3.07, 95% CI=1.45-6.50, p=0.003), and 23.5% (OR=5.84, 95% CI=2.87-11.89, p<0.001). CONCLUSIONS Anemia was common in this cohort of subjects with acute HF and was related to adverse short-term outcome. Integrated use of hemoglobin and NT-proBNP measurements provides powerful additive information and is superior to the use of either in isolation.
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Affiliation(s)
- Aaron L Baggish
- PRIDE Study Group, and Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
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38
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Abstract
Current medical therapy of heart failure (HF) focuses primarily on blockade of the neurohormonal pathways. This approach appears to have reached a benefit plateau, despite the introduction of new and improved drugs. Therefore, new targets for pharmacologic intervention are now being actively sought, and anemia has emerged as a potential candidate. Anemia is a frequently occurring comorbidity in patients with HF. However, its true prevalence is difficult to determine because no uniform definition of anemia associated with HF currently exists. Therefore, reported prevalence data can vary significantly, ranging from 4% to 55%, depending on the study population and the applied definition of anemia. Data from recent observational studies and clinical trials suggest that a low hemoglobin concentration in patients with HF is associated with, and is an independent risk factor for, increased morbidity and mortality. In light of these findings, anemia is being discussed as a possible new treatment target in patients with HF. So far, however, only a few small studies have explored this possibility using erythropoiesis-stimulating proteins, which for many years have been successfully used in the treatment of anemia secondary to chronic kidney disease or cancer chemotherapy. Preliminary data from these initial HF studies have shown that increased hemoglobin concentrations in patients with anemia were associated with improvements in cardiac and renal function as well as exercise capacity and a reduced need for hospitalizations. Larger, controlled clinical trials are needed to clearly establish the benefits and safety aspects of anemia treatment on morbidity and possibly mortality in HF patients.
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Affiliation(s)
- Judith E Mitchell
- Heart Failure Program, State University of New York Health Science Center, Brooklyn, New York 11203, 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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40
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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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41
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Elabbassi W, Fraser M, Williams K, Cassan D, Haddad H. Prevalence and Clinical Implications of Anemia in Congestive Heart Failure Patients Followed at a Specialized. ACTA ACUST UNITED AC 2006; 12:258-64. [PMID: 17033274 DOI: 10.1111/j.1527-5299.2006.05336.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to assess the prevalence of anemia and to investigate its association with comorbidities and its impact on clinical outcomes in patients with heart failure. The association of predefined anemia, as well as the correlation of serum hemoglobin level as a continuous variable, with outcomes of emergency department visits, hospitalization, and mortality was investigated. There were fewer anemic patients in New York Heart Association classes I and II than in classes III and IV. Anemia was associated with higher rates of emergency department visits, hospital admissions, and all-cause mortality. Multivariable analysis showed that anemia is independently associated with mortality. When hemoglobin level was considered as a continuous variable, the authors noted that the mortality risk correlated with hemoglobin level disappears when hemoglobin level exceeds 140 g/L. The authors conclude that anemia has strong impacts on functional class and other clinical outcomes in patients with heart failure.
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Affiliation(s)
- Wael Elabbassi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada K1Y 4W7
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42
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Berry C, Norrie J, Hogg K, Brett M, Stevenson K, McMurray JJV. The prevalence, nature, and importance of hematologic abnormalities in heart failure. Am Heart J 2006; 151:1313-21. [PMID: 16781243 DOI: 10.1016/j.ahj.2005.07.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 07/30/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anemia is an adverse prognostic marker in heart failure (HF), but its cause and relationships with other comorbidities are uncertain. METHODS All index emergency HF admissions to one urban hospital during the year 2000 were studied. RESULTS Of 528 consecutive admissions with HF, 45% of patients (51% men and 38% women) had anemia (Hb <13 g/dL in men and <11.5 in women), which was usually normocytic. Anemia was equally common in patients with reduced and preserved systolic function. Hematinic deficiencies were rare, but 162 (70%) of anemic patients were lymphopenic. Median (interquartile range) C-reactive protein was higher in anemic patients compared with nonanemic patients (21 [5-211] mg/L vs 13 [5-155] mg/L, P = .0086). Marked reductions in glomerular filtration rate (<30 mL/min per 1.73m(2)) were more common in anemic patients (24%) than nonanemic patients (9%) (P < .0001). Median follow-up was 814 days (range 632-978 days). One hundred twenty-five (54%) anemic patients died, compared with 93 (32%) nonanemic patients (P < .00001), and anemia was a predictor of death (in patients with reduced or preserved systolic function) and death or hospital readmission. CONCLUSIONS Renal dysfunction is one probable cause of anemia in HF. The overlap of anemia and lymphopenia suggest that hematopoiesis may be more generally depressed. Anemia is a predictor of adverse outcome in HF, irrespective of systolic function.
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Affiliation(s)
- Colin Berry
- Department of Cardiology, Western Infirmary, Glasgow, Scotland
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Geisberg C, Nading MA, Listerman J, Huang R, Goring J, Butler J. Anemia in Heart Failure May Warrant More Aggressive Listing for Cardiac Transplantation. Transplant Proc 2006; 38:1499-500. [PMID: 16797342 DOI: 10.1016/j.transproceed.2006.02.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Indexed: 11/21/2022]
Abstract
Peak exercise oxygen consumption (VO2, in mL/min/kg) is a reliable prognostic marker in heart failure (HF). Anemia, which is common in HF, affects both exercise capacity and prognosis. In this study, we assessed the relationship between peak VO2 and prognosis among HF patients with and without anemia. Data on 344 HF patients were divided into three groups based on peak VO2 (<10, 10 to 14, and >14). Each group stratified by the presence of anemia (<13 mg/dL in men and <12 mg/dL in women) was compared for death or left ventricular assist device (LVAD) placement, and death or LVAD or transplantation. The mean patient age was 53.4+/-11.8 years; hemoglobin level, 12.8+/-1.8 mg/dL; and average follow-up, 629+/-459 days. Overall 32% of patients were anemic. The presence of anemia significantly impacted outcomes among patients with peak VO2<10, namely 42.2% versus 18.9% death or LVAD need (P=.01) and 66.7% versus 43.3% death or LVAD or transplantation (P=.06) for anemic versus nonanemic patients, respectively. The prognosis was similar among groups with higher peak VO2. After adjusting for baseline differences, anemic patients with peak VO2<10 were at higher risk for adverse outcomes: odds ratio (OR) 3.69 (95% confidence interval [95% CI] 1.31 to 9.87) for death or LVAD; and OR 5.67 (95% CI=1.42 to 19.4) for death or LVAD or transplant. Anemia significantly impacted the prognosis of HF patients with peak VO2 less than 10 mL/min/kg. Since these patients are most likely to be evaluated for transplantation, the presence of anemia may further help to stratify prognosis in this group.
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Affiliation(s)
- C Geisberg
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee 37232-6300, USA
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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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45
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Formiga F, Chivite D, Castañer O, Manito N, Ramón JM, Pujol R. Anemia in new-onset congestive heart failure inpatients admitted for acute decompensation. Eur J Intern Med 2006; 17:179-84. [PMID: 16618450 DOI: 10.1016/j.ejim.2005.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 09/22/2005] [Accepted: 11/10/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anemia may have important deleterious effects on patients with heart failure. We investigated the presence and causes of anemia among patients admitted because of new-onset congestive heart failure. The prognostic value of anemia was also evaluated. METHODS We evaluated the presence of anemia, which was defined as hemoglobin concentrations lower than 13g/dl in men and lower than 12g/dl in women. One-year mortality and hospital readmission rates were also studied. RESULTS A total of 103patients were included in the study. Their mean age was 78.5years and 53% were women. Mean hemoglobin levels were 12.4g/l. Forty-four patients (43%) had anemia at the time of hospital admission, 34 of them had true anemia and 10spurious anemia caused by hemodilution. Patients taking preadmission angiotensin-converting enzyme inhibitors had more severe anemia than those not taking them (p<0.01). The presence of anemia was not associated with an increase in mortality (p=0.3) or in readmission rates (p=0.1) after 1year of follow-up. CONCLUSIONS Anemia is frequent in new-onset heart failure patients admitted for acute decompensation. However, the presence of anemia does not seem to be related to an increase in mortality or readmission in this small cohort.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Besarab A, Soman S. Anemia Management in Chronic Heart Failure: Lessons Learnt from Chronic Kidney Disease. Kidney Blood Press Res 2006; 28:363-71. [PMID: 16534232 DOI: 10.1159/000090191] [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: 11/19/2022] Open
Abstract
The importance of anemia in chronic kidney disease (CKD) has become increasingly well recognized over recent years, as have the benefits of treating anemic CKD patients with recombinant human erythropoietin (rHuEPO, epoetin). As well as reducing the need for blood transfusions and the complications associated with renal failure in CKD patients, rHuEPO treatment decreases patient morbidity and mortality, particularly as a result of cardiovascular disease. The strong correlation between anemia, renal failure and cardiac failure is one that has received much attention recently, with each factor recognized to cause the other to worsen in a 'vicious cycle'. Recent studies have concentrated on the possible benefits of anemia treatment in patients with CHF. Currently available data suggest improvements in CHF symptoms, left ventricular ejection fraction (LVEF) and a reduction of hospitalizations associated with anemia correction through epoetin treatment. Available data from CKD patients suggest that anemia management should begin as early as possible, although the optimal target level for individual patients is as yet unclear. In addition to the currently available evidence, additional large, randomized, controlled studies are required to further define the morbidity/mortality benefits of epoetin treatment in CHF patients with anemia.
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Affiliation(s)
- Anatole Besarab
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI 48202, USA.
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47
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Luthi JC, Flanders WD, Burnier M, Burnand B, McClellan WM. Anemia and chronic kidney disease are associated with poor outcomes in heart failure patients. BMC Nephrol 2006; 7:3. [PMID: 16515712 PMCID: PMC1413523 DOI: 10.1186/1471-2369-7-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 03/06/2006] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has been linked to higher heart failure (HF) risk. Anemia is a common consequence of CKD, and recent evidence suggests that anemia is a risk factor for HF. The purpose of this study was to examine among patients with HF, the association between CKD, anemia and inhospital mortality and early readmission. METHODS We performed a retrospective cohort study in two Swiss university hospitals. Subjects were selected based the presence of ICD-10 HF codes in 1999. We recorded demographic characteristics and risk factors for HF. CKD was defined as a serum creatinine > or = 124 956;mol/L for women and > or = 133 micromol/L for men. The main outcome measures were inhospital mortality and thirty-day readmissions. RESULTS Among 955 eligible patients hospitalized with heart failure, 23.0% had CKD. Twenty percent and 6.1% of individuals with and without CKD, respectively, died at the hospital (p < 0.0001). Overall, after adjustment for other patient factors, creatinine and hemoglobin were associated with an increased risk of death at the hospital, and hemoglobin was related to early readmission. CONCLUSION Both CKD and anemia are frequent among older patients with heart failure and are predictors of adverse outcomes, independent of other known risk factors for heart failure.
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Affiliation(s)
- Jean-Christophe Luthi
- Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
- Health Observatory, Canton of Valais, Switzerland
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, USA
| | - W Dana Flanders
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | - Bernard Burnand
- Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - William M McClellan
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, USA
- Georgia Medical Care Foundation, Atlanta, USA
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48
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Recio Iglesias J. Réplica. Rev Clin Esp 2006. [DOI: 10.1157/13086220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Felker GM, Shaw LK, Stough WG, O'Connor CM. Anemia in patients with heart failure and preserved systolic function. Am Heart J 2006; 151:457-62. [PMID: 16442914 DOI: 10.1016/j.ahj.2005.03.056] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 03/30/2005] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anemia has been shown to be a predictor of mortality in patients with heart failure and impaired left ventricular systolic function (ISF). Although heart failure in the setting of preserved systolic function (PSF) is an important clinical problem, the relationship between anemia and outcomes in patients with PSF has not been carefully evaluated. METHODS Patients undergoing diagnostic angiography from 1995 to 2003 with symptomatic heart failure (New York Heart Association class II or greater) were studied (N = 4951). Patients with primary valvular or congenital heart disease were excluded. Patients with ejection fraction < or = 0.40 (N = 1858) were considered the ISF group, and patients with ejection fraction > 0.40 (N = 3093) were classified as the PSF group. Anemia was defined by the World Health Organization criteria (hemoglobin < 13 g/dL for men and < 12 g/dL for women). Multivariable Cox proportional hazards models were used to adjust for baseline differences. The possibility of a differential effect of anemia by systolic function was tested using an interaction term in the multivariable model. RESULTS Anemia was independently associated with adverse outcomes across the study cohort (adjusted hazard ratio = 1.53, P < .0001). There was no interaction between anemia and systolic function (ISF vs PSF) in the multivariable model (P = .31 for interaction). The hazard ratio for anemia was 1.61 for PSF patients and 1.45 for ISF patients. CONCLUSIONS Anemia is an independent predictor of mortality in heart failure, regardless of whether patients have preserved or impaired systolic function. This is the first report of an association between anemia and increased mortality in patients with heart failure and PSF. Future investigations of therapies for anemia in heart failure should consider including patients with PSF.
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50
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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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