title: Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis.
abstract: BACKGROUND
  Anaemia is common among patients with heart failure (HF) and is an important prognostic marker.
  
  
  OBJECTIVE
  We sought to determine the prognostic importance of anaemia in a large multinational pooled dataset of prospectively enrolled HF patients, with the specific aim to determine the prognostic role of anaemia in HF with preserved and reduced ejection fraction (HF-PEF and HF-REF, respectively).
  
  
  METHODS
  Individual person data meta-analysis.
  
  
  METHODS
  Patients with haemoglobin (Hb) data from the MAGGIC dataset were used. Anaemia was defined as Hb < 120 g/l in women and <130 g/l in men. HF-PEF was defined as EF ≥ 50%; HF-REF was EF < 50%. Cox proportional hazard modelling, with adjustment for clinically relevant variables, was undertaken to investigate factors associated with 3-year all-cause mortality.
  
  
  RESULTS
  Thirteen thousand two hundred and ninety-five patients with HF from 19 studies (9887 with HF-REF and 3408 with HF-PEF). The prevalence of anaemia was similar among those with HF-REF and HF-PEF (42.8 and 41.6% respectively). Compared with patients with normal Hb values, those with anaemia were older, were more likely to have diabetes, ischaemic aetiology, New York Heart Association class IV symptoms, lower estimated glomerular filtration rate and were more likely to be taking diuretic and less likely to be taking a beta-blocker. Patients with anaemia had higher all-cause mortality (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.25-1.51), independent of EF group: aHR 1.67 (1.39-1.99) in HF-PEF and aHR 2.49 (2.13-2.90) in HF-REF.
  
  
  CONCLUSIONS
  Anaemia is an adverse prognostic factor in HF irrespective of EF. The prognostic importance of anaemia was greatest in patients with HF-REF.
authors.affiliation: From the 1 BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: C
authors.initials: C
authors.lastname: Berry
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: K K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: G D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: N J
authors.initials: NJ
authors.lastname: Earle
authors.affiliation: Division of Cardiology, University of Alberta, Edmonton, Canada.
authors.forename: J A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: I B
authors.initials: IB
authors.lastname: Squire
authors.affiliation: From the 1 BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: J J V
authors.initials: JJV
authors.lastname: McMurray
authors.affiliation: Division of Cardiology, University of Alberta, Edmonton, Canada.
authors.forename: F A
authors.initials: FA
authors.lastname: McAlister
authors.affiliation: Department of Cardiology, University Pierre & Marie Curie (UPMC), Paris, France.|Pitie Salpetriere Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Komajda
authors.affiliation: Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: ANMCO Research Centre, Florence, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham and the Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Faculty of Social and Health Sciences, Unitec Institute of Technology, Auckland, New Zealand and.
authors.forename: G A
authors.initials: GA
authors.lastname: Whalley
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: R N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: Department of Cardiology, Heart Failure Unit, Ospedale S. Martino, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tarantini
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*