CLINICAL RESEARCH: CLINICAL TRIAL
Anemia predicts mortality in severe heart failure
The prospective randomized amlodipine survival evaluation (PRAISE)
Dariush Mozaffarian, MD, MPH* ,*,
Regina Nye, MPH and
Wayne C. Levy, MD
* Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
Division of Cardiology, University of Washington, Seattle, USA
Pfizer PGRD, New London, Connecticut, USA
Manuscript received September 23, 2002;
revised manuscript received February 6, 2003,
accepted February 20, 2003.
* Reprint requests and correspondence: Dr. Dariush Mozaffarian, VA Puget Sound Health Care System, 1660 South Columbian Way, MS 152, Seattle, Washington 98108, USA. darymd{at}hotmail.com
OBJECTIVES: Our aim was to examine the relationships between serum hematocrit (Hct) and risk of all-cause mortality among patients with severe heart failure (HF).
BACKGROUND: Anemia occurs with increased frequency in severe HF. However, few studies have examined the impact of anemia on mortality in this population.
METHODS: Using a prospective cohort design, we evaluated the relationships between baseline serum Hct and mortality among 1,130 patients with left ventricular EF <30% and New York Heart Association functional class IIIB or IV HF treated with angiotensin-converting enzyme inhibitors, diuretics, and digitalis. Mortality was ascertained by centralized adjudication.
RESULTS: The mean Hct was 41.8% (range 25.4% to 58.8%). Over 15 months of mean follow-up, there were 407 deaths (29 per 100 person-years). After adjustment for potential confounders, those in the lowest quintile of Hct (range 25.4% to 37.5%) had a 52% higher risk of death (hazard ratio 1.52, 95% confidence interval 1.11 to 2.10), compared with the highest quintile (range 46.1% to 58.8%). Within the lowest quintile of Hct, each 1% decrease in Hct was associated with an 11% higher risk of death (p < 0.01), whereas within the four higher quintiles of Hct, Hct was not associated with total mortality. Evaluation of different causes of death indicated that a lower Hct was strongly associated with death from progressive HF, rather than sudden death or other deaths.
CONCLUSIONS: Among patients with severe HF, anemia is a significant independent risk factor for death, with a progressively higher risk with increasing severity of anemia. Further investigation of the etiologies, prevention, and treatment of anemia in severe HF is warranted.
|
Abbreviations and Acronyms
| | CI | | confidence interval | | EF | | ejection fraction | | Hct | | hematocrit | | HF | | heart failure | | HR | | hazard ratio | | MI | | myocardial infarction | | NYHA | | New York Heart Association | | PRAISE | | Prospective Randomized Amlodipine Survival Evaluation |
|
This article has been cited by other articles:

|
 |

|
 |
 
S. A. Krikorian
Managing Anemia of Chronic Kidney Disease
American Journal of Lifestyle Medicine,
March 1, 2009;
3(2):
135 - 146.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
E. D. Pagourelias, C. Koumaras, A. I. Kakafika, K. Tziomalos, P. G. Zorou, V. G. Athyros, and A. Karagiannis
Cardiorenal Anemia Syndrome: Do Erythropoietin and Iron Therapy Have a Place in the Treatment of Heart Failure?
Angiology,
February 1, 2009;
60(1):
74 - 81.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
H. F. Groenveld, J. L. Januzzi, K. Damman, J. van Wijngaarden, H. L. Hillege, D. J. van Veldhuisen, and P. van der Meer
Anemia and Mortality in Heart Failure Patients: A Systematic Review and Meta-Analysis
J. Am. Coll. Cardiol.,
September 2, 2008;
52(10):
818 - 827.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W.H. W. Tang, W. Tong, A. Jain, G. S. Francis, C. M. Harris, and J. B. Young
Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure.
J. Am. Coll. Cardiol.,
February 5, 2008;
51(5):
569 - 576.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. K. Ghali, I. S. Anand, W. T. Abraham, G. C. Fonarow, B. Greenberg, H. Krum, B. M. Massie, S. M. Wasserman, M.-L. Trotman, Y. Sun, et al.
Randomized Double-Blind Trial of Darbepoetin Alfa in Patients With Symptomatic Heart Failure and Anemia
Circulation,
January 29, 2008;
117(4):
526 - 535.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. S. Desai, K. Bibbins-Domingo, M. G. Shlipak, A. H.B. Wu, S. Ali, and M. A. Whooley
Association between anaemia and N-terminal pro-B-type natriuretic peptide (NT-proBNP): Findings from the Heart and Soul Study
Eur J Heart Fail,
September 1, 2007;
9(9):
886 - 891.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. K. Spence
Medical and economic impact of anemia in hospitalized patients
Am. J. Health Syst. Pharm.,
August 15, 2007;
64(16_Supplement_11):
S3 - S10.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. P. Steensma and A. Tefferi
Anemia in the Elderly: How Should We Define It, When Does It Matter, and What Can Be Done?
Mayo Clin. Proc.,
August 1, 2007;
82(8):
958 - 966.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Ponikowski, S. D. Anker, J. Szachniewicz, D. Okonko, M. Ledwidge, R. Zymlinski, E. Ryan, S. M. Wasserman, N. Baker, D. Rosser, et al.
Effect of Darbepoetin Alfa on Exercise Tolerance in Anemic Patients With Symptomatic Chronic Heart Failure: A Randomized, Double-Blind, Placebo-Controlled Trial
J. Am. Coll. Cardiol.,
February 20, 2007;
49(7):
753 - 762.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. W. Dec
Anemia in Heart Failure: Time to Rethink Its Etiology and Treatment?
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2490 - 2492.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J D Newton and I B Squire
Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure
Heart,
October 1, 2006;
92(10):
1441 - 1446.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. P. Bolger, F. R. Bartlett, H. S. Penston, J. O'Leary, N. Pollock, R. Kaprielian, and C. M. Chapman
Intravenous Iron Alone for the Treatment of Anemia in Patients With Chronic Heart Failure
J. Am. Coll. Cardiol.,
September 19, 2006;
48(6):
1225 - 1227.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. S. Go, J. Yang, L. M. Ackerson, K. Lepper, S. Robbins, B. M. Massie, and M. G. Shlipak
Hemoglobin Level, Chronic Kidney Disease, and the Risks of Death and Hospitalization in Adults With Chronic Heart Failure: The Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study
Circulation,
June 13, 2006;
113(23):
2713 - 2723.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Komajda, S. D. Anker, A. Charlesworth, D. Okonko, M. Metra, A. Di Lenarda, W. Remme, C. Moullet, K. Swedberg, J. G.F. Cleland, et al.
The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
Eur. Heart J.,
June 2, 2006;
27(12):
1440 - 1446.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L Grigorian Shamagian, A Varela Roman, J M Garcia-Acuna, P Mazon Ramos, A Virgos Lamela, and J R Gonzalez-Juanatey
Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function
Heart,
June 1, 2006;
92(6):
780 - 784.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Y.-D. Tang and S. D. Katz
Anemia in Chronic Heart Failure: Prevalence, Etiology, Clinical Correlates, and Treatment Options
Circulation,
May 23, 2006;
113(20):
2454 - 2461.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. F. Culleton, B. J. Manns, J. Zhang, M. Tonelli, S. Klarenbach, and B. R. Hemmelgarn
Impact of anemia on hospitalization and mortality in older adults
Blood,
May 15, 2006;
107(10):
3841 - 3846.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. C. Levy, D. Mozaffarian, D. T. Linker, S. C. Sutradhar, S. D. Anker, A. B. Cropp, I. Anand, A. Maggioni, P. Burton, M. D. Sullivan, et al.
The Seattle Heart Failure Model: Prediction of Survival in Heart Failure
Circulation,
March 21, 2006;
113(11):
1424 - 1433.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. O'Meara, T. Clayton, M. B. McEntegart, J. J.V. McMurray, C. C. Lang, S. D. Roger, J. B. Young, S. D. Solomon, C. B. Granger, J. Ostergren, et al.
Clinical Correlates and Consequences of Anemia in a Broad Spectrum of Patients With Heart Failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program
Circulation,
February 21, 2006;
113(7):
986 - 994.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. Felker, W. G. Stough, L. K. Shaw, and C. M. O'Connor
Anaemia and coronary artery disease severity in patients with heart failure
Eur J Heart Fail,
January 1, 2006;
8(1):
54 - 57.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Opasich, M. Cazzola, L. Scelsi, S. De Feo, E. Bosimini, R. Lagioia, O. Febo, R. Ferrari, A. Fucili, R. Moratti, et al.
Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure
Eur. Heart J.,
November 1, 2005;
26(21):
2232 - 2237.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. T. Vlagopoulos, H. Tighiouart, D. E. Weiner, J. Griffith, D. Pettitt, D. N. Salem, A. S. Levey, and M. J. Sarnak
Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes: The Impact of Chronic Kidney Disease
J. Am. Soc. Nephrol.,
November 1, 2005;
16(11):
3403 - 3410.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. L. Spivak
Anemia in the Elderly: Time for New Blood in Old Vessels?
Arch Intern Med,
October 24, 2005;
165(19):
2187 - 2189.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Kosiborod, J. P. Curtis, Y. Wang, G. L. Smith, F. A. Masoudi, J. M. Foody, E. P. Havranek, and H. M. Krumholz
Anemia and Outcomes in Patients With Heart Failure: A Study From the National Heart Care Project
Arch Intern Med,
October 24, 2005;
165(19):
2237 - 2244.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. van der Meer, E. Lipsic, B. D. Westenbrink, R. M.A. van de Wal, R. G. Schoemaker, E. Vellenga, D. J. van Veldhuisen, A. A. Voors, and W. H. van Gilst
Levels of Hematopoiesis Inhibitor N-Acetyl-Seryl-Aspartyl-Lysyl-Proline Partially Explain the Occurrence of Anemia in Heart Failure
Circulation,
September 20, 2005;
112(12):
1743 - 1747.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Philipp, H. Ollmann, T. Schink, R. Dietz, F. C. Luft, and R. Willenbrock
The impact of anaemia and kidney function in congestive heart failure and preserved systolic function
Nephrol. Dial. Transplant.,
May 1, 2005;
20(5):
915 - 919.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
U. Dahlstrom
Frequent non-cardiac comorbidities in patients with chronic heart failure
Eur J Heart Fail,
March 16, 2005;
7(3):
309 - 316.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Ishani, E. Weinhandl, Z. Zhao, D. T. Gilbertson, A. J. Collins, S. Yusuf, and C. A. Herzog
Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction
J. Am. Coll. Cardiol.,
February 1, 2005;
45(3):
391 - 399.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. J.V. McMurray and M. A. Pfeffer
The year in heart failure
J. Am. Coll. Cardiol.,
December 21, 2004;
44(12):
2398 - 2405.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. Caiola and J. W. Cheng
Use of Erythropoietin in Heart Failure Management
Ann. Pharmacother.,
December 1, 2004;
38(12):
2145 - 2149.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G.M. Felker, K. F. Adams Jr, W. A. Gattis, and C. M. O'Connor
Anemia as a risk factor and therapeutic target in heart failure
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
959 - 966.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. G. Shlipak, G. L. Smith, S. S. Rathore, B. M. Massie, and H. M. Krumholz
Renal Function, Digoxin Therapy, and Heart Failure Outcomes: Evidence from the Digoxin Intervention Group Trial
J. Am. Soc. Nephrol.,
August 1, 2004;
15(8):
2195 - 2203.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
I. Anand, J. J.V. McMurray, J. Whitmore, M. Warren, A. Pham, M. A. McCamish, and P. B.J. Burton
Anemia and Its Relationship to Clinical Outcome in Heart Failure
Circulation,
July 13, 2004;
110(2):
149 - 154.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. van der Meer, A. A. Voors, E. Lipsic, T. D. J. Smilde, W. H. van Gilst, and D. J. van Veldhuisen
Prognostic value of plasma erythropoietin on mortality in patients with chronic heart failure
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
63 - 67.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C Nielson and D Wingete
Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities
Chronic Respiratory Disease,
January 1, 2004;
1(1):
43 - 54.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
H. Taegtmeyer and S. Sharma
Anemia and energy depletion
J. Am. Coll. Cardiol.,
December 3, 2003;
42(11):
2030 - 2030.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Mozaffarian and W. Levy
Anemia and energy depletion: reply
J. Am. Coll. Cardiol.,
December 3, 2003;
42(11):
2030 - 2030.
[Full Text]
[PDF]
|
 |
|
|