Heart Failure
Outcomes of Patients With Anemia and Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction (from the ARIC Study Community Surveillance)

https://doi.org/10.1016/j.amjcard.2014.09.024Get rights and content

Anemia is associated with poor prognosis in patients hospitalized with acute decompensated heart failure (ADHF). Whether the impact of anemia differs by heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) is uncertain. We examined hospital surveillance data captured by the Atherosclerosis Risk in Communities Study from January 1, 2005, to December 31, 2010. Diagnoses of ADHF were validated by standardized physician review of the medical record. Anemia was classified using the World Health Organization criteria (<12 g/dl for women and <13 g/dl for men), and HF type was determined by the ejection fraction (<40% for HFrEF and ≥40% for HFpEF). Hospital length of stay and 1-year mortality outcomes were analyzed by multivariable regression, weighted to account for the sampling design, and adjusted for demographics and clinical covariates. Over 6 years, 15,461 (weighted) hospitalized events for ADHF (59% HFrEF) occurred in the catchment of the Atherosclerosis Risk in Communities, based on 3,309 sampled events. Anemia was associated with a mortality hazard ratio of 2.1 (95% confidence interval [CI] 1.6 to 2.7) in patients classified with HFpEF and 1.4 (95% CI 1.1 to 1.7) in those with HFrEF; p for interaction = 0.05. The mean increase in length of hospital stay associated with anemia was 3.5 days (95% CI 3.4 to 3.6) for patients with HFpEF, compared with 1.8 days (95% CI 1.7 to 1.9) for those with HFrEF; p for interaction <0.0001. In conclusion, the incremental risks of death and lengthened hospital stay associated with anemia are more pronounced in ADHF patients classified with HFpEF than HFrEF.

Section snippets

Methods

Since 2005, the ARIC study has conducted population-based retrospective surveillance of hospitalized events in Forsyth County, North Carolina; Washington County, Maryland; Jackson, Mississippi; and 8 northwest suburbs of Minneapolis, Minnesota. Surveillance eligibility is restricted to residents ≥55 years, with a hospitalization spanning at least 1 day and, for the purposes of our analysis, a discharge date between January 1, 2005, and December 31, 2010. Hospitalizations with any discharge

Results

All results are weighted to account for the sampling design, unless otherwise indicated. Of 15,461 hospitalizations with verified ADHF, 6,414 (41%) were classified as HFpEF and 9,047 (59%) as HFrEF. The mean age at discharge was 76 years; approximately half (52%) were women, and nearly 1/3 (29%) were black. The overall anemia prevalence was 70% and did not differ by HF type (p = 0.4). In unadjusted analyses, hemoglobin was positively correlated with glomerular filtration rate (r = 0.21; p

Discussion

In this population-based sample of patients hospitalized with ADHF, anemia was associated with both greater mortality risk and longer hospital stays. We observed significantly stronger associations in patients with HFpEF, which remained robust when examining hemoglobin as a continuous measure.

Many studies have established anemia as risk factor for death in HF patients; however, comparisons of risk by HF type have been inconsistent for hospitalized ADHF. In a study from the National Heart Care

Acknowledgment

The authors thank the staff and participants of the ARIC study for their important contributions.

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