title: Prognostic significance of hemoglobin level in patients with congestive heart failure and normal ejection fraction.
abstract: BACKGROUND
  Previous studies have shown low hemoglobin (Hb) to have an adverse effect on survival in patients with congestive heart failure (CHF) and reduced left ventricular (LV) ejection fraction (EF); but its effect on survival in patients with CHF and normal EF is not known.
  
  
  OBJECTIVE
  This study sought to determine whether low Hb has an effect on survival in patients with both CHF and normal EF.
  
  
  METHODS
  Detailed chart reviews were performed by medical residents on 2,246 patients (48% with normal EF) with a discharge diagnosis of CHF in a large tertiary care hospital from 1990 to 1999. The CHF diagnosis was validated using the Framingham criteria. Mortality data were obtained from the National Death Index. Survival analysis was performed using Kaplan-Meier and Cox regression models.
  
  
  RESULTS
  By Kaplan-Meier analysis, low Hb (< 12 gm/dl) compared with normal hemoglobin was associated with a lower 5-year survival in patients with CHF and both normal (38 vs. 50%, p = 0.0008) and reduced (35 vs. 48%, p = 0.0009) EF. Using the Cox regression model, low Hb was an independent predictor of mortality after adjusting for age, gender, renal dysfunction, diabetes mellitus, hypertension, and EF in both groups of patients.
  
  
  CONCLUSIONS
  Low Hb has an independent adverse effect on survival in patients with CHF and both normal and reduced EF in both groups of patients.
authors.affiliation: Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Siddharth
authors.initials: S
authors.lastname: Gandhi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Branavan
authors.initials: B
authors.lastname: Umakanthan
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000747:Anemia, Hypochromic; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D014463:Ultrasonography
chemical_list: D006454:Hemoglobins