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CLINICAL RESEARCH: HEART FAILURE

Evaluation and Long-Term Prognosis of New-Onset, Transient, and Persistent Anemia in Ambulatory Patients With Chronic Heart Failure

W.H. Wilson Tang, MD, FACC^_*,1,_*, Wilson Tong, MSc^_*, Anil Jain, MD^,, Gary S. Francis, MD, FACC^_*,1, C. Martin Harris, MD, MBA and James B. Young, MD, FACC^_*,1

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
Information Technology Division, Cleveland Clinic, Cleveland, Ohio.

Manuscript received May 14, 2007; revised manuscript received July 20, 2007, accepted July 23, 2007.

^_* Reprint requests and correspondence: Dr. W. H. Wilson Tang, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195. (Email: tangw{at}ccf.org).

Objectives: This study sought to determine the characteristics and long-term prognosis of anemia in ambulatory patients with chronic heart failure.

Background: Anemia is prevalent in heart failure, and may portend poor outcomes.

Methods: We reviewed 6,159 consecutive outpatients with chronic stable heart failure at baseline, short-term (3-month) follow-up, and long-term (6-month) follow-up between 2001 and 2006. Clinical, demographic, laboratory, and echocardiographic data were reviewed from electronic medical records. Mortality rates were determined from 6-month follow-up to end of study period.

Results: Prevalence of anemia (hemoglobin [Hb] <12 g/dl for men, <11 g/dl for women) was 17.2% in our cohort. Diabetes, B-natriuretic peptide, left ventricular ejection fraction, and estimated glomerular filtration rate were independent predictors of baseline anemia. Documented evaluation of anemia was found in only 3% of all anemic patients, and better in internal medicine than in cardiology clinics. At 6-month follow-up, new-onset anemia developed in 16% of patients without prior anemia, whereas 43% patients with anemia at baseline had resolution of their hemoglobin levels. Higher total mortality rates were evident in patients with persistent anemia (58% vs. 31%, p < 0.0001) or with incident anemia (45% vs. 31%, p < 0.0001) compared with those with without anemia at 6 months.

Conclusions: These observations in a broad unselected outpatient cohort suggest that anemia in patients with heart failure is under-recognized and underevaluated. However, resolution of anemia was evident in up to 43% of patients who presented initially with anemia, and did not pose greater long-term risk for all-cause mortality. However, the presence of persistent anemia conferred poorest survival in patients with heart failure when compared with that of incident, resolved, or no anemia.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BNP = B-type natriuretic peptide   eGFR = estimated glomerular filtration rate   Hb = hemoglobin   ICD-9 = International Classification of Diseases-Ninth Revision   LVEF = left ventricular ejection fraction   MCV = mean corpuscular volume

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