Anemia Is Common in Heart Failure and Is Associated With Poor Outcomes

TLDR

Anemia has been linked to higher mortality in selected CHF patients, but its prevalence, predictors, and independent prognostic value in unselected community-based CHF patients remain unclear. The study aims to investigate anemia mechanisms in CHF and assess whether correcting anemia improves prognosis. The authors analyzed a population-based cohort of 12,065 new‑onset CHF patients from Alberta hospitals and applied logistic regression, Kaplan–Meier, and Cox models to evaluate anemia prevalence and outcomes. Anemia was present in 17% of patients, mainly chronic disease type, and was independently associated with higher mortality (HR 1.34–1.36), confirming its prevalence and prognostic significance in community CHF patients.

Abstract

Background— Although previous work has suggested that anemia is associated with an increased mortality in selected patients with congestive heart failure (CHF), little is known about the prevalence and predictors of anemia, or whether anemia is an independent prognostic factor in unselected, community-based patients with CHF. Methods and Results— We analyzed a population-based cohort of patients with new-onset CHF from a database of patients discharged from 138 acute-care hospitals in Alberta, Canada, between April 1993 and March 2001. Logistic regression, Kaplan-Meier survival analyses, and Cox proportional hazards model were used. Among the 12 065 patients with CHF (median age 78 years), 17% had anemia, 58% of whom had anemia of chronic disease. After adjustment for clinical and demographic variables, patients with anemia were more likely to be older (odds ratio [OR] 1.01 per year) and female (OR 1.2 [95% confidence interval 1.1 to 1.3]) and to have a history of chronic renal insufficiency (OR=3.2 [95% confidence interval 2.8 to 3.6]), or hypertension (OR 1.3 [95% confidence interval 1.2 to 1.5]). Hazard ratios for mortality, adjusting for covariates, were 1.34 (1.24 to 1.46) in anemic patients, and 1.36 (1.23 to 1.50) in those patients with anemia of chronic disease. Conclusions— In this large cohort of community-dwelling patients with CHF, anemia is common and an independent prognostic factor for mortality. Further research into the mechanisms of anemia in CHF and randomized controlled trials to test whether correction of anemia improves prognosis in CHF are needed.