What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (ADHF) (n=3652). Intervention: Anemia vs. No anemia. Primary outcome: All-cause mortality in 1-year (HR 1.213, 95% CI 1.054-1.396, p=0.007).

October 4, 2023Open Access

Prevalence of, association with, severity of, and prognostic role of serum hemoglobin level in acutely decompensated heart failure patients

Key Result

Anemia was an independent predictor of 1-year all-cause mortality in patients with acute decompensated heart failure, associated with a 21% increased risk (HR 1.213) compared to non-anemic patients.

Study Design

Type

Cohort (n=3,652)

Multicenter

Structured PICO

Does anemia at admission increase 1-year all-cause mortality in patients with acute decompensated heart failure?

Population

3,652 adults with acute decompensated heart failure (ADHF), mean age 70.01, 62.5% male, from the PROVE-HF registry in Iran. Excluded: malignant diseases, primary bone marrow diseases, concurrent corticosteroid-based medication, active bleeding, hereditary hemoglobinopathies, hemolytic anemia, megaloblastic anemia, anemia due to nutrient deficiencies, and those who died during hospitalization.

Intervention

Anemia (hemoglobin < 13 g/dL in males, < 12 g/dL in females) and polycythemia (hemoglobin > 16.5 g/dL in males, > 16 g/dL in females) at admission.

Comparator

Normal hemoglobin levels (non-anemic, non-polycythemic patients).

Outcome

All-cause mortality at 1-year follow-up.hard clinical

Anemia at admission is an independent adverse prognostic factor for 1-year all-cause mortality in patients with acute decompensated heart failure, particularly those with moderate anemia.

Main Result

Effect estimate: HR 1.213 (95% CI 1.054-1.396)

Absolute Event Rate: 28.5% vs 20.9%

p-value: p=0.007

Limitations

Observational nature of research and lack of information about the etiology of anemia
No data to differentiate primary and secondary polycythemia
No data on hemoglobin at discharge to differentiate transient from persistent anemia
Most patients were HF-exacerbated, preventing comparison with new-onset HF
Lack of data on SGLT2 inhibitors
Exclusion of patients who died in the hospital

Abstract

BACKGROUND: The role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF. METHODS: Using the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb 16.5 g/dLit in males and 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables. RESULTS: Of 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI 1.054-1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308-2.458) and females (aHR 1.790, 95% CI 1.312-2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05). CONCLUSIONS: This study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients.

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