The prevalence and clinical significance of anemia in patients hospitalized with acute heart failure

Anemia (Hb<12 g/dl or Ht<35%) is relatively frequent in patients with heart failure (HF). In a population of patients with newly diagnosed HF the prevalence of anemia was 17%¹. The presence of anemia is related to the severity of functional class (from 9% in NYHA class I to 79% in class IV)². In acute heart failure (AHF) anemia, regardless of its etiology, could be an important extracardiac factor of decompensation; its diagnosis, evaluation and treatment being an important part of management. Also, the presence of anemia proved to be an important prognostic factor during the in-hospital and post-discharge period³.

The aim of this study was to assess a cohort of patients hospitalized with AHF for (1) the prevalence of anemia and (2) the existence of a correlation between anemia and the severity of the clinical picture.

Methods

We collected data from 50 consecutive patients (34 men, 16 women, mean age 67.5 years) hospitalized with AHF (acute decompensated heart failure in 36 cases). At admission, all the patients signed the general consent form used at our institution, agreeing with anonymous data collection and usage for scientific purposes. Approval of the hospital ethical committee (permit number: 3865/01.03.2016) was obtained for data processing and publication. Exclusion criteria were: recent (<1 month) acute coronary syndrome, and advanced renal disease on hemodialysis. At admission and during hospital stay routine (part of usual care) clinical and paraclinical data were recorded in a dedicated database: demographic data, clinical diagnosis, triggering factors of decompensation, signs and symptoms at admission, ECG data, echocardiographic data, laboratory parameters at admission, and treatment data. Statistical analysis was performed using a chi-square test (MS Excel 2010) for studying univariate correlation between anemia and the presence of diverse parameters reflecting the severity of AHF (α=0.05).

Results

21 patients (14 men, 7 women, mean age 69.6 years), representing 42% of the cohort, had anemia (Hb<12 g/dl) at admission. The most common forms were chronic simple anemia (8 patients) and renal anemia (6 patients). We did not find significant differences between the two groups of patients, with and without anemia, with regards to gender (p=1) and age (p=0.57). Also, there were no significant differences regarding the presence of atrial fibrillation (p=0.75), diabetes (p=1), ischemic heart disease (p=0.9), ejection fraction < 35% (p=1), hypotension (systolic BP <90 mmHg) at admission (p=0.34), tachycardia>100 b/min at admission (p=0.75), creatinine level >1.5mg% (p=0.12), and need of high dose of loop diuretic >80 mg/day (p=0.23).

Discussion and conclusions

There is general agreement that anemia is a good predictor of prognosis in patients with acute and chronic HF. Anemia is associated with increased mortality, however there are conflicted data whether this is an independent predictor or reflects the progression of HF and/or is related to the presence of more frequent comorbidities^1,4,5. In the setting of AHF, anemia could also serve as a precipitating factor of decompensation.

In our cohort of patients the presence of anemia was not correlated with other factors related to AHF severity and prognosis. This fact suggests its independent role in influencing the clinical picture and prognosis.

Data availability

F1000Research: Dataset 1. Patient data, 10.5256/f1000research.7872.d122902⁶

Consent

Written informed consent for publication of their clinical details was obtained from the patients.