Mortality in heart failure with worsening anemia: a national study.
BACKGROUND
Anemia is common in heart failure (HF), but there is controversy regarding its contribution to morbidity and mortality.


OBJECTIVE
To examine the association of mild and severe anemia with acute HF severity and mortality.


METHODS
Data were prospectively collected for patients admitted to all departments of medicine and cardiology throughout the country during 2 months in 2003 as part of the Heart Failure Survey in Israel. Anemia was defined as hemoglobin (Hb) < 12 g/dl for women and < 13 g/dl for men; Hb < 10 g/dl was considered severe anemia. Mortality data were obtained from the Israel population registry. Median follow-up was 33.6 months.


RESULTS
Of 4102 HF patients, 2332 had acute HF and available hemoglobin data. Anemia was common (55%) and correlated with worse baseline HF. Most signs and symptoms of acute HF were similar among all groups, but mortality was greater in anemic patients. Mortality rates at 6 months were 14.9%, 23.7% and 26.3% for patients with no anemia, mild anemia and severe anemia, respectively (P < 0.0001), and 22.2%, 33.6% and 39.9% at one year, respectively (P < 0.0001). Compared to patients without anemia, multivariable adjusted hazard ratio was 1.35 for mild anemia and 1.50 for severe anemia (95% confidence interval 1.20-1.52 and 1.27-1.77 respectively).


CONCLUSIONS
Anemia is common in patients with acuteHF and is associated with increased mortality correlated with the degree of anemia.
Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. howardo@tlvmc.gov.il
Howard S
HS
Oster
Michal
M
Benderly
Michael
M
Hoffman
Eytan
E
Cohen
Avraham
A
Shotan
Moshe
M
Mittelman
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006306:Health Surveys; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013223:Statistics as Topic; D015996:Survival Rate
D006454:Hemoglobins