title: Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction.
abstract: BACKGROUND
  Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA).
  
  
  RESULTS
  We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year.
  
  
  CONCLUSIONS
  HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Salisbury
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D000368:Aged; D000740:Anemia; D018450:Disease Progression; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins