The interaction among sex, hemoglobin and outcomes in a specialty heart failure clinic.
OBJECTIVE
Although anemia has recently been demonstrated to be a marker for poor outcomes in patients with congestive heart failure (CHF), the impact of sex on the prevalence and prognostic impact of anemia has not been adequately explored. Accordingly, the relationship among sex, anemia and outcomes in CHF was analyzed.


METHODS
Patients seen at a specialty CHF clinic from 1989 to 2001.


METHODS
A retrospective analysis of prospectively collected data was performed using chi2 and Student's t tests to determine the association between anemia and mortality. Multivariate Cox proportional hazards models were used to measure the independent association of anemia with mortality in men and women. The World Health Organization definition of anemia (less than 130 g/L for men; less than 120 g/L for women) and the Centers for Disease Control and Prevention definition of anemia (less than 135 g/L for men, less than 120 g/L for women) were used, and hemoglobin was assessed as a continuous variable.


RESULTS
There were 791 patients with CHF seen over a 12-year period (median age 69 years, median hemoglobin of 131 g/L [interquartile range 119 to 144 g/L]) and 34% were women. The demographics and treatments were similar for men and women, except that women were older (69 years versus 65 years, P<0.001), more likely to have a nonischemic etiology of CHF (P<0.001) or diastolic dysfunction (P<0.001), and lower creatinine clearances (P<0.001). Forty per cent of men and 35% of women were anemic using the World Health Organization definition. Anemia was associated with a one-year and five-year excess mortality in men (adjusted OR 1.7 [1.1 to 2.5] and 1.76 [1.2 to 2.7], respectively), but this was not observed in women (adjusted OR 1.2 [0.7 to 2.2] and 1.2 [0.7 to 2.1], respectively).


CONCLUSIONS
Anemia is prevalent in heart failure and predicts mortality in men but not in women. Given this result, the authors recommend that randomized trials evaluating novel therapies for the correction of anemia in patients with heart failure should stratify their randomization by sex.
Ezekowitz
Justin A
JA
Division of Cardiology, University of Alberta, Edmonton, Alberta T6G 2H7. justin.ezekowitz@ualberta.ca
McAlister
Finlay A
FA
Armstrong
Paul W
PW
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000401:mortality*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002037:Bundle-Branch Block / Q000150:complications / Q000401:mortality; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D003404:Creatinine / Q000652:urine; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000145:classification / Q000150:complications / Q000401:mortality*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D013148:Spironolactone / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D006454:Hemoglobins; D000451:Mineralocorticoid Receptor Antagonists; D014665:Vasodilator Agents; D013148:Spironolactone; D003404:Creatinine