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)

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 > School of Health & 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