title: Associations between hemoglobin level, resource use, and medical costs in patients with heart failure: findings from HF-ACTION.
abstract: BACKGROUND
  Reports that patients with heart failure and anemia incur greater costs and medical resource use have relied largely on data with limited clinical detail.
  
  
  METHODS
  HF-ACTION, a large trial of exercise training in heart failure, recorded hemoglobin at baseline. Medical resource use and hospital bills for inpatient and emergency department visits were collected throughout the study. We analyzed hemoglobin as a continuous variable to evaluate relationships with medical resource use and costs over 1 year.
  
  
  RESULTS
  Among 1,763 patients with baseline hemoglobin levels, those with lower hemoglobin levels tended to be older, African American, and women and to have more severe heart failure. Lower hemoglobin was significantly associated with more hospital admissions, inpatient days, outpatient visits, and urgent care or emergency department visits (all P < .005, unadjusted). Although cost outliers influenced estimates, these observations were distributed across hemoglobin levels. Mean 1-year costs across hemoglobin levels defined as ≤ 11, >11-12, >12-13, >13-14, >14-15, and >15 g/dL were $21,106, $20,189, $16,249, $17,989, $13,216, and $12,492, respectively (P < .001, unadjusted). Significant associations remained after multivariable adjustment.
  
  
  CONCLUSIONS
  Patients with lower baseline hemoglobin levels experienced progressively greater resource use and higher costs.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina 27715, USA. shelby.reed@duke.edu
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: John J
authors.initials: JJ
authors.lastname: Isitt
authors.forename: Sunfa
authors.initials: S
authors.lastname: Cheng
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006333:Heart Failure / Q000097:blood / Q000191:economics* / Q000473:pathology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins