title: Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial.
abstract: BACKGROUND
  Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge.
  
  
  RESULTS
  An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1).
  
  
  CONCLUSIONS
  Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Haris P
authors.initials: HP
authors.lastname: Subacius
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.). m-gheorghiade@northwestern.edu.
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D000740:Anemia / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood; D010343:Patient Admission; D010351:Patient Discharge; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate
chemical_list: D045265:Natriuretic Peptides; D003404:Creatinine
keywords: anemia; heart failure; hemoglobin; hospitalization
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