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J Am Coll Cardiol, 2003; 41:1933-1939, doi:10.1016/S0735-1097(03)00425-X
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CLINICAL TRIAL

Anemia predicts mortality in severe heart failure

The prospective randomized amlodipine survival evaluation (PRAISE)

Dariush Mozaffarian, MD, MPH*{dagger},*, Regina Nye, MPH{ddagger} and Wayne C. Levy, MD{dagger}

* Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
{dagger} Division of Cardiology, University of Washington, Seattle, USA
{ddagger} 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




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