Higher hemoglobin is associated with better survival in coronary artery disease, heart failure with reduced ejection fraction, and chronic kidney disease

Background: Anemia is a common comorbidity in patients with heart failure (HF) or chronic kidney disease (CKD) and could be associated with worse clinical outcomes. However, to date, the impact of anemia on survival in a complex triple-comorbidity of coronary artery disease (CAD), HF with reduced ejection fraction (HFrEF), and CKD remains inconclusive. Methods: ) from our cardiac catheterization laboratory between January 2010 and September 2019. Clinical and laboratory variables were recorded from traceable chart records from our hospital. All-cause and cardiovascular mortality were counted until December 2019 and served as study outcomes. Results: A total of 128 subjects with CAD, HFrEF and CKD were analyzed. Anemia was prevalent (81/128 = 63.3 %) in this complex disease combination. The median follow-up duration was 36 months and 77 subjects (60.1 %) died. Cox survival analysis revealed that higher baseline hemoglobin (hazard ratio 0.864, 95 % CI 0.753-0.992, per 1 g/dl increase), higher eGFR, better EF, and the use of beta-blockers were associated with lower all-cause mortality. Conclusions: A higher baseline admission hemoglobin value was associated with lower all-cause mortality in subjects with significant CAD, HFrEF, and CKD.