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J Am Coll Cardiol, 2002; 39:1780-1786
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY

Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure

Tamara B. Horwich, MD*, Gregg C. Fonarow, MD, FACC{dagger},*, Michele A. Hamilton, MD, FACC{dagger}, W. Robb MacLellan, MD, FACC{dagger} and Jeff Borenstein, MD{ddagger}

* Department of Medicine, University of California, Los Angeles, USA
{dagger} Ahmanson–University of California Cardiomyopathy Center, Los Angeles, USA
{ddagger} Cedars–Sinai Health System, Los Angeles, California, USA

Manuscript received December 28, 2001; revised manuscript received March 4, 2002, accepted March 11, 2002.

* Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson–UCLA Cardiomyopathy Center, UCLA Division of Cardiology, 47-123 CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095-1679, USA.
gfonarow{at}mednet.ucla.edu

OBJECTIVES: This study aimed to evaluate the relationship between anemia and heart failure (HF) prognosis.

BACKGROUND: Although it is known that chronic diseases, including HF, may be associated with anemia, the impact of hemoglobin (Hb) level on symptoms and survival in HF has not been fully defined.

METHODS: We analyzed a cohort of 1,061 patients with advanced HF (New York Heart Association [NYHA] functional class III or IV and left ventricular ejection fraction [LVEF] <40%) referred to a single center for evaluation and management. The Hb level was drawn at time of initial evaluation. Patients were divided into quartiles of Hb: Hb <12.3; Hb 12.3 to 13.6; Hb 13.7 to 14.8; Hb >14.8 g/dl.

RESULTS: Mean Hb was 13.6, and values ranged from 7.1 to 19.0 g/dl. The Hb groups were similar in age, medication profile, LVEF, hypertension, diabetes, smoking status and serum sodium. Lower Hb was associated with an impaired hemodynamic profile, higher blood urea nitrogen and creatinine, and lower albumin, total cholesterol and body mass index. Patients in the lower Hb quartiles were more likely to be NYHA functional class IV (p < 0.0001) and have lower peak oxygen consumption (PKVO2) (p < 0.0001). Survival at one year was higher with increased Hb quartile (55.6%, 63.9%, 71.4% and 74.4% for quartiles 1, 2, 3 and 4, respectively). On multivariate analysis adjusting for known HF prognostic factors, low Hb proved to be an independent predictor of mortality (relative risk 1.131, confidence interval 1.045 to 1.224 for each decrease of 1 g/dl).

CONCLUSIONS: In chronic HF, relatively mild degrees of anemia are associated with worsened symptoms, functional status and survival.

Abbreviations and Acronyms
  BMI
  body mass index
  CAD
  coronary artery disease
  CI
  confidence interval
  ESRD
  end-stage renal disease
  Hb
  hemoglobin
  Hct
  hematocrit
  HF
  heart failure
  LVEF
  left ventricular ejection fraction
  MI
  myocardial infarction
  NYHA
  New York Heart Association
  PKVO2
  peak oxygen consumption
  RR
  relative risk
  SOLVD
  Studies Of Left Ventricular Dysfunction




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