Clinical research studyAnemia and Heart Failure: A Community Study
Section snippets
Study Design and Setting
This is a population-based study conducted in Olmsted County, Minnesota, using the resources of the Rochester Epidemiology Project. According to the US Census Bureau (www.census.gov), the 2005 Olmsted County population is estimated at 135,189, the majority of whom are white (90.2%) and 50.8% of whom are women.
We used 2 complementary study designs in this analysis: a retrospective cohort including patients with incident heart failure diagnosed from 1979 to 2002 and a prospective cohort enrolling
Patient Populations
There were 1063 patients with heart failure in the retrospective cohort and 677 patients in the prospective cohort. Age and sex distributions in both cohorts were similar. The prospective cohort had an increased proportion of patients with higher BMI, hypertension, diabetes, coronary artery disease, smoking, chronic obstructive pulmonary disease, and malignancy (P < .001 for all).
Retrospective Cohort
The prevalence of anemia was 40% and increased over time (Figure 1), with an estimated increase of 0.67% annually.
Discussion
In community patients with heart failure, the prevalence of anemia is high and increasing over time. Currently, anemia is present in more than half of patients with heart failure and is considerably more prevalent in those with preserved ejection fraction. Anemia is associated with a large increase in mortality independently of known clinical characteristics. The relationship between hemoglobin and mortality is not linear, because both reduced (<14 mg/dL) and elevated (≥16 mg/dL) hemoglobin are
Conclusions
More than half of community patients with heart failure are currently anemic and the prevalence is increasing over time. Patients with heart failure with preserved ejection fraction have an increased prevalence of anemia compared with patients with reduced ejection fraction. Anemia is associated with increased mortality, but hemoglobin follows a J-shaped curve, with increased mortality at both low and very high hemoglobin levels. Further work is needed to investigate the increasing prevalence
Acknowledgments
We thank Ellen Koepsell, RN, and Kay Traverse, RN, for study support.
References (32)
- et al.
The prognostic importance of anemia in patients with heart failure
Am J Med
(2003) - et al.
Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure
J Am Coll Cardiol
(2002) - et al.
Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction
J Am Coll Cardiol
(2001) - et al.
Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE)
J Am Coll Cardiol
(2003) - et al.
Anaemia is an independent predictor of poor outcome in patients with chronic heart failure
Int J Cardiol
(2003) - et al.
Anemia in patients with heart failure and preserved systolic function
Am Heart J
(2006) History of the Rochester Epidemiology Project
Mayo Clin Proc
(1996)- et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Superiority of visual versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction
Am Heart J
(1989) - et al.
Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia
Blood
(2004)
Relation of anemia to diastolic heart failure and the effect on outcome
Am J Cardiol
Anemia and heart failure a new pathway?
J Am Coll Cardiol
Anemia in chronic heart failure: pathogenetic mechanisms
J Card Fail
The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study
J Am Coll Cardiol
Effect of darbepoetin alfa on exercise tolerance in anemic patients with symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled trial
J Am Coll Cardiol
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
Circulation
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2014, Mayo Clinic ProceedingsCitation Excerpt :Intravenous iron therapy improves exercise capacity in iron-deficient patients with HF. Anemia is associated with increased morbidity and mortality among patients with HF53,54 and is more common in women and patients with HFpEF. Given the prevalence of anemia in HF and associated adverse effects, there has been interest in using iron and erythropoietin therapy.
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2014, American Journal of CardiologyCitation Excerpt :We omitted hospitalizations with no abstracted hemoglobin values (n = 33) or ejection fraction (n = 576) and patients transferred to or from another hospital (n = 77). In addition, we excluded patients receiving dialysis (n = 337), as this represents a distinct subgroup of anemic HF, and patients identified with polycythemia (n = 19) because of the known U-shaped relation between hemoglobin and mortality risk.17–19 After exclusions, 3,309 unweighted events remained in analysis, corresponding to 15,461 weighted hospitalizations for definite (79%) or probable (21%) ADHF.
This study was supported by grants from the National Institute of Health (RO1 HL 59205, RO1 HL 72435) and by an American Heart Association Postdoctoral Greater Midwest Fellowship Award to Dr Dunlay. Dr Roger is an Established Investigator of the American Heart Association.