Anemia in adults with congenital heart disease relates to adverse outcome.
OBJECTIVE
To assess the relation of anemia in noncyanotic adults with congenital heart disease (ACHD) to functional capacity and mortality.


BACKGROUND
Anemia is common in acquired heart failure and affects prognosis. The presence of anemia and its relation to outcome in ACHD remain unknown.


METHODS
Data were collected on consecutive noncyanotic ACHD patients attending our tertiary center between 2001 and 2006 in whom hemoglobin concentration was measured. Anemia was defined as hemoglobin concentration <13 g/dl in males and <12 g/dl in females. Cyanotic patients were excluded to avoid confounding from secondary erythrocytosis.


RESULTS
Overall, 830 noncyanotic ACHD patients (age 36.5 +/- 15.0 years, 49.6% male) fulfilled the inclusion criteria. The prevalence of anemia was 13.1% and was highest in patients with congenitally corrected transposition of great arteries and Ebstein anomaly of the tricuspid valve. Anemic patients were more likely to be receiving diuretics (p < 0.0001) and have a lower mean corpuscular volume (p = 0.0001), with a trend toward a higher New York Heart Association functional class (p = 0.06). During a median follow-up of 47 months, 55 patients died. Anemic patients had a 3-fold higher mortality risk compared with nonanemic patients, even after propensity score adjustment for clinical variables such as systemic ventricular function, renal impairment, and diuretic therapy (adjusted hazard ratio: 3.00; 95% confidence interval: 1.46 to 6.13).


CONCLUSIONS
Anemia is not uncommon in ACHD patients attending tertiary services and is associated with a 3-fold increased risk of death. Screening for anemia should be part of the routine assessment of ACHD patients for risk stratification and treatment when correctable causes are identified.
Dimopoulos
Konstantinos
K
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom. k.dimopoulos02@ic.ac.uk
Diller
Gerhard-Paul
GP
Giannakoulas
Georgios
G
Petraco
Ricardo
R
Chamaidi
Aikaterini
A
Karaoli
Evaggelia
E
Mullen
Michael
M
Swan
Lorna
L
Piepoli
Massimo F
MF
Poole-Wilson
Philip A
PA
Francis
Darrel P
DP
Gatzoulis
Michael A
MA
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D004437:Ebstein Anomaly / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D018570:Risk Assessment; D014188:Transposition of Great Vessels / Q000601:surgery; D055815:Young Adult
D006454:Hemoglobins