title: Recovery from hospital-acquired anemia after acute myocardial infarction and effect on outcomes.
abstract: New-onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) is independently associated with poor outcomes. The patterns of recovery from HAA after AMI and their association with mortality and health status are unknown. In the prospective 24-center Translational Research Investigating Underlying disparities in acute myocardial infarction Patients' Health Status (TRIUMPH) registry, we identified 530 patients with AMI and HAA (defined as normal hemoglobin at admission with the development of anemia by discharge) who had a repeat, protocol-driven hemoglobin measurement at 1 month after discharge. The 1-month measures were used to define persistent (persistent anemia) and transient (anemia resolved) HAA. The patients' health status was assessed at 1, 6, and 12 months after AMI using the Short-Form 12 Physical Component Summary, and the health status of patients with persistent and transient HAA was compared using multivariate repeated measures regression analysis. Mortality was compared using the log-rank test and proportional hazards regression analysis. Overall, 165 patients (31%) developed persistent HAA. The adjusted mean Short-Form 12 Physical Component Summary scores at the follow-up visit were significantly lower in those with persistent HAA than in those with transient HAA (-2.0 points, 95% confidence interval -3.6 to -0.3; p = 0.02). During a median follow-up of 36 months, the crude mortality (13% vs 5%, p = 0.002) and multivariate-adjusted mortality (hazard ratio 2.08, 95% confidence interval 1.02 to 4.21, p = 0.04) was greater in patients with persistent HAA. In conclusion, HAA persists 1 month after discharge in nearly 1 of 3 patients and is associated with worse health status and greater mortality. Additional investigation is needed to understand whether HAA prevention, recognition, and treatment, particularly among those with persistent HAA, will improve outcomes.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA. salisburya@umkc.edu
authors.forename: Adam C
authors.initials: AC
authors.lastname: Salisbury
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D003289:Convalescence; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D054624:Health Status Disparities; D006454:Hemoglobins / Q000378:metabolism; D006753:Hospital Records / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins