Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program.
BACKGROUND
We wished to determine the prevalence of, potential mechanistic associations of, and clinical outcomes related to anemia in patients with heart failure and a broad spectrum of left ventricular ejection fraction (LVEF).


RESULTS
In multivariable analyses, we examined the associations between hemoglobin and baseline characteristics, laboratory variables, and outcomes in 2653 patients randomized in the CHARM Program in the United States and Canada. Anemia was equally common in patients with preserved (27%) and reduced (25%) LVEF but was more common in black and older patients. Anemia was associated with ethnicity, diabetes, low body mass index, higher systolic and lower diastolic blood pressure, and recent heart failure hospitalization. More than 50% of anemic patients had a glomerular filtration rate <60 mL.min(-1).1.73 m(-2) compared with <30% of nonanemic patients. Despite an inverse relationship between hemoglobin and LVEF, anemia was associated with an increased risk of death and hospitalization, a relationship observed in patients with both reduced and preserved LVEF. There were 133 versus 69 deaths and 527 versus 352 hospitalizations per 1000 patient-years of follow-up in anemic versus nonanemic patients (both P<0.001). The effect of candesartan in reducing outcomes was independent of hemoglobin.


CONCLUSIONS
Anemia was common in heart failure, regardless of LVEF. Lower hemoglobin was associated with higher LVEF yet was an independent predictor of adverse mortality and morbidity outcomes. In heart failure, the causes of anemia and the associations between anemia and outcomes are probably multiple and complex.
O'Meara
Eileen
E
Western Infirmary, Glasgow, UK.
Clayton
Tim
T
McEntegart
Margaret B
MB
McMurray
John J V
JJ
Lang
Chim C
CC
Roger
Simon D
SD
Young
James B
JB
Solomon
Scott D
SD
Granger
Christopher B
CB
Ostergren
Jan
J
Olofsson
Bertil
B
Michelson
Eric L
EL
Pocock
Stuart
S
Yusuf
Salim
S
Swedberg
Karl
K
Pfeffer
Marc A
MA
D000368:Aged; D000740:Anemia / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D001562:Benzimidazoles / Q000494:pharmacology; D001713:Biphenyl Compounds; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D013318:Stroke Volume; D013777:Tetrazoles / Q000494:pharmacology; D016896:Treatment Outcome
D001562:Benzimidazoles; D001713:Biphenyl Compounds; D006454:Hemoglobins; D013777:Tetrazoles; C081643:candesartan