January 1, 2015Circulation Journal49 citationsOpen Access

Prognostic Impact of Anemia in Patients With Chronic Heart Failure　– With Special Reference to Clinical Background: Report From the CHART-2 Study –

TYTakeshi Yamauchi YSYasuhiko Sakata TTTsuyoshi Takada

Structured PICO

Does anemia increase mortality in patients with Stage C/D chronic heart failure?

Population

4,646 consecutive patients with Stage C/D chronic heart failure (CHF) registered in the CHART-2 Study, mean age 68.9, 31.9% female, Japanese cohort.

Intervention

Presence of anemia (defined by WHO criteria: Hb <13 g/dl in men and <12 g/dl in women)

Comparator

Absence of anemia

Outcome

All-cause death at median 3.8 years follow-uphard clinical

Anemia is a strong independent predictor of all-cause mortality in patients with chronic heart failure, particularly in those with preserved ejection fraction and hypertension.

Limitations

Only analyzed clinical data at the time of registration, without considering possible changes in Hb levels during follow-up
Subtype of anemia was unknown because data on erythropoietin, ferritin, or folic acid were not available
Prospective observational study with Japanese CHF patients, so caution is needed when generalizing to other populations

Abstract

BACKGROUND: We aimed to elucidate the prognostic impact of anemia with special reference to the clinical background of patients with chronic heart failure (CHF). METHODS AND RESULTS: We examined 4,646 consecutive patients with Stage C/D CHF registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (n=10,219). Among them, 1,627 (35%) had anemia and were characterized by higher age (74 vs. 66 years), lower estimated glomerular filtration rate (52.8 vs. 66.1 ml/min/1.73 m(2)) and higher B-type natriuretic peptide levels (154.5 vs. 81.8 pg/ml) (all P<0.001) but comparable left ventricular ejection fraction (LVEF; 57.5 vs. 56.7%). Anemic patients were more frequently treated with diuretics (55.1 vs. 42.3%) but less often treated with β-blockers (45.4 vs. 51.1%) (both P<0.001). During a median follow-up of 3.8 years, 371 and 272 patients died with and without anemia, respectively (22.8 vs. 9.0%, adjusted hazard ratio 1.40; 95% confidence interval 1.15-1.71, P=0.001). Subgroup analysis revealed that the prognostic impact of anemia was comparable in terms of age, sex, renal function and double product, but differed by LVEF level and CHF etiology (both, P for interaction <0.001). In particular, a difference in the prognostic impact of LVEF level was noted in patients with ischemic heart disease. CONCLUSIONS: These results indicate that the prognostic impact of anemia is evident in CHF patients with preserved EF and it differs by CHF etiology.

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