Prevalence and outcomes of anemia and hematinic deficiencies in patients with chronic heart failure

Cleland, J. G.F. , Zhang, J., Pellicori, P. , Dicken, B., Dierckx, R., Shoaib, A., Wong, K., Rigby, A., Goode, K. and Clark, A. L. (2016) Prevalence and outcomes of anemia and hematinic deficiencies in patients with chronic heart failure. JAMA Cardiology, 1(5), pp. 539-547. (doi:10.1001/jamacardio.2016.1161) (PMID:27439011)

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Abstract

Importance: Detailed information on the prevalence, associations, and consequences of anemia and iron deficiency in epidemiologically representative outpatients with chronic heart failure (HF) is lacking. Objective: To investigate the epidemiology of anemia and iron deficiency in a broad range of patients referred to a cardiology clinic with suspected HF. Design, Setting, and Participants: We collected clinical data, including hemoglobin, serum iron, transferrin saturation, and serum ferritin concentrations, on consecutive patients referred with suspected HF to a single outpatient clinic serving a local community from January 1, 2001, through December 31, 2010. Follow-up data were censored on December 13, 2011. Patients underwent phenotyping by echocardiography and plasma N-terminal pro–brain natriuretic peptide measurement and were followed for up to 10 years. Main Outcome Measures: Prevalences of anemia and iron deficiency and their interrelationship, all-cause mortality, and cardiovascular mortality. Results: Of 4456 patients enrolled in the study, the median (interquartile range) age was 73 (65-79) years, 2696 (60.5%) were men, and 1791 (40.2%) had left ventricular systolic dysfunction (LVSD). Of those without LVSD, plasma N-terminal pro–brain natriuretic peptide concentration was greater than 400 pg/mL in 1172 (26.3%), less than 400 pg/mL in 841 (18.9%), and not measured in 652 (14.6%). Overall, 1237 patients (27.8%) had anemia, with a higher prevalence (987 [33.3%]) in patients who met the criteria for HF with or without LVSD. Depending on the definition applied, iron deficiency was present in 270 (43.2%) to 425 (68.0%) of patients with and 260 (14.7%) to 624 (35.3%) of patients without anemia. Lower hemoglobin (hazard ratio 0.92; 95% CI, 0.89-0.95; P < .001) and serum iron (hazard ratio 0.98; 95% CI, 0.97-0.99; P = .007) concentrations were independently associated with higher all-cause and cardiovascular mortality in multivariable analyses. Conclusions and Relevance: Anemia is common in patients with HF and often associated with iron deficiency. Both anemia and iron deficiency are associated with an increase in all-cause and cardiovascular mortality and might both be therapeutic targets in this population.

Item Type:Articles
Additional Information:Acquisition of data and analyses was funded from a variety of resources, predominantly by the National Heart Service as part of routine clinical service supplemented by core support provided by the UK government as a result of success in the Research Excellence Framework. This funding was supplemented by grants from Vifor Pharma and Amgen Inc to support investigation of anemia and iron deficiency in HF.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Cleland, J. G.F., Zhang, J., Pellicori, P., Dicken, B., Dierckx, R., Shoaib, A., Wong, K., Rigby, A., Goode, K., and Clark, A. L.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JAMA Cardiology
Publisher:American Medical Association
ISSN:2380-6583
ISSN (Online):2380-6591
Published Online:29 June 2016
Copyright Holders:Copyright © 2016 American Medical Association
First Published:First published in JAMA Cardiology 1(5): 539-547
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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