What is the clinical evidence from this study?

Study design: Observational. Population: Acute decompensated heart failure (n=771). Intervention: New-onset anemia vs. No anemia. Primary outcome: Composite of all-cause death or HF hospitalization (HR 2.73, 95% CI 1.19-6.25, p=0.02).

August 13, 2021Open Access

Improved and new-onset anemia during follow-up in patients with acute decompensated heart failure

Key Result

New-onset anemia at 6-month follow-up after discharge for acute decompensated heart failure was associated with a significantly higher risk of all-cause death or heart failure hospitalization (HR 2.73).

Study Design

Type

Observational (n=771)

Multicenter

Yes

Structured PICO

Does new-onset or persistent anemia increase the risk of all-cause death or HF hospitalization in patients with acute decompensated heart failure?

Population

771 patients with acute decompensated heart failure (ADHF) followed in multicenters in Japan

Intervention

Anemia status at 6-month index visit (persistent anemia, new-onset anemia, improved anemia)

Comparator

No anemia

Outcome

Composite of all-cause death or HF hospitalization after index visitcomposite

Persistent and new-onset anemia at 6 months post-discharge for ADHF are associated with a higher risk of all-cause death or HF hospitalization, highlighting the importance of monitoring anemia during follow-up.

Main Result

Effect estimate: HR 2.73 (95% CI 1.19-6.25)

Absolute Event Rate: 18.5% vs 9.2%

p-value: p=0.02

Limitations

Laboratory test at 6-month visit was not available in a substantial proportion of patients.
Data on post-discharge drugs were not available in a substantial proportion of patients.
Observational study design is subject to selection bias and residual confounding.
Excluded some population groups such as acute coronary syndrome and end-stage renal failure.
Did not have information about the etiology of anemia, urine output, and complete volume status.
Unknown whether anemia progressed after 6-month visit.

Abstract

ABSTRACT: There was no previous report on the prognostic impact of new-onset or improved anemia after discharge from acute decompensated heart failure (ADHF).We analyzed 771 patients with ADHF and who were followed in multicenters in Japan was divided into 4 groups based on the hemoglobin values at discharge and 6-month index visit: 373 patients (48.4%) with persistent anemia, 87 patients (11.3%) with new-onset anemia, 91 patients (11.8%) with improved anemia, and 220 patients (28.5%) without anemia.The primary outcome measure was a composite of all-cause death or HF hospitalization after index visit. The cumulative 6-month incidences of the primary outcome measure were 25.2% for persistent anemia, 18.5% for new onset anemia, 9.0% for improved anemia, and 9.2% for no anemia (log-rank P < .001). Compared with the no anemia group, the excess risk for the primary outcome measure remained significant in the persistent anemia group hazard ratio (HR) 2.70, 95% confidence interval (95% CI), 1.45-5.44, P = .001 and in the new-onset anemia group (HR 2.73, 95% CI 1.19-6.25, P = .02), while it was not significant in the improved anemia group (HR 1.69, 95% CI 0.68-4.03, P = .25).Persistent and new-onset anemia at 6-month visit were associated with a subsequent higher risk for all-cause death or HF hospitalization in patients with ADHF, suggesting the importance of detecting anemia during follow-up.

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