Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice.
BACKGROUND
Aims of the present study were (1) to confirm the prognostic role of anemia in patients with heart failure (HF) and (2) to analyze this aspect in relatively unselected patients with HF monitored prospectively in a community setting (IN-CHF), and in patients selected for enrollment into the Valsartan Heart Failure Trial (Val-HeFT).


RESULTS
In both Val-HeFT and IN-CHF Registry, anemia was defined as a hemoglobin (Hb) level < or = 11 g/dL in women and < or = 12 g/dL in men. Of the 2411 patients of the IN-CHF Registry, 15.5% had anemia, whereas in the 5010 patients of the Val-HeFT trial, the prevalence was 9.9%. In the IN-CHF registry, 1-year all-cause mortality was significantly higher in anemic patients (25.9%) than in patients without anemia (13.2%) (P < .0001). The association of anemia with mortality was confirmed by the multivariable analysis (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97). The risk of death decreased by 9.7% for each gram of Hb. The Val-HeFT trial showed an all-cause mortality rate for anemic patients of 29.6% over a mean follow-up period of 22.4 months versus 18.5% (P < .0001) in patients without anemia. After adjustment, anemia retained its negative independent prognostic role (HR 1.26, 95% CI 1.04-1.52). When Hb was considered as a continuous variable, the risk of death decreased by 7.8% for each gram of Hb.


CONCLUSIONS
Anemia was confirmed to be an independent negative prognostic factor in patients with HF. This finding is consistent in 2 different clinical contexts, a controlled trial and a registry in clinical practice, in which patient characteristics and outcome are largely different.
Maggioni
Aldo P
AP
Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy.
Opasich
Cristina
C
Anand
Inder
I
Barlera
Simona
S
Carbonieri
Emanuele
E
Gonzini
Lucio
L
Tavazzi
Luigi
L
Latini
Roberto
R
Cohn
Jay
J
D000368:Aged; D000740:Anemia / Q000150:complications* / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012306:Risk; D012737:Sex Factors; D016019:Survival Analysis; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
D000959:Antihypertensive Agents; D006454:Hemoglobins; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine