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document
Anemia and associated clinical outcomes in patients with heart failure due to reduced left ventricular systolic function . BACKGROUND Anemia is associated with decreased functional capacity , reduced quality of life , and worsened outcomes among patients with heart failure ( HF ) due to reduced left ventricular ejection fraction ( HFREF ) . We sought to evaluate the independent effect of anemia on clinical outcomes among those with HFREF . HYPOTHESIS Anemia is associated with cardiovascular events in patients with heart failure . METHODS The HF-ACTION trial was a prospective , randomized trial of exercise therapy vs usual care in 2331 patients with HFREF . Patients with New York Heart Association class II to IV HF and left ventricular ejection fractions of ≤ 35 % were recruited . Hemoglobin ( Hb ) was measured up to 1 year prior to entry and was stratified by quintile . Anemia was defined as baseline Hb < 13 g/dL and < 12 g/dL in men and women , respectively . Hemoglobin was assessed in 2 models : a global prediction model that had been previously developed , and a modified model including variables associated with anemia and the studied outcomes . RESULTS Hemoglobin was available at baseline in 1763 subjects ( 76 % of total study population ) ; their median age was 59.0 years , 73 % were male , and 62 % were Caucasian . The prevalence of anemia was 515/1763 ( 29 % ) . Older age , female sex , African American race , diabetes , hypertension , and lower estimated glomerular filtration rates were all more frequent in lower Hb quintiles . Over a median follow-up of 30 months , the primary outcome of all-cause mortality or all-cause hospitalization occurred in 78 % of those with anemia and 64 % in those without ( P < 0.001 ) . The secondary outcomes of all-cause mortality alone , cardiovascular ( CV ) mortality or CV hospitalization , and CV mortality or HF hospitalization occurred in 23 % vs 15 % , 67 % vs 54 % , and 44 vs 29 % , respectively ( P < 0.001 ) . Heart failure hospitalizations occurred in 36 % vs 22 % , and urgent outpatient visits for HF exacerbations occurred in 67 % and 55 % , respectively ( P < 0.001 ) . For the global model , there was an association observed for anemia and all-cause mortality or hospitalization ( adjusted hazard ratio [ HR ] : 1.15 , 95 % confidence interval [ CI ] : 1.01-1.32 , P = 0.04 ) , but other outcomes were not significant at P < 0.05 . In the modified model , the adjusted HR for anemia and the primary outcome of all-cause mortality or all-cause hospitalization was 1.25 ( 95 % CI : 1.10-1.42 , P < 0.001 ) . There were independent associations between anemia and all-cause death ( HR : 1.11 , 95 % CI : 0.87-1.42 , P = 0.38 ) , CV death or CV hospitalization ( HR : 1.16 , 95 % CI : 1.01-1.33 , P = 0.035 ) , and CV death and HF hospitalization ( HR : 1.27 , 95 % CI : 1.06-1.51 , P = 0.008 ) . CONCLUSIONS Anemia modestly is associated with increased rates of death , hospitalization , and HF exacerbation in patients with chronic HFREF . After adjusting for other important covariates , anemia is independently associated with an excess hazard for all-cause mortality and all-cause hospitalization . Anemia is also associated with combinations of CV death and CV/HF hospitalizations as composite endpoints .
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Intervention_Physical
exercise therapy vs usual care
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Outcome_Other
recruited
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Outcome_Physical
Hemoglobin ( Hb )
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Outcome_Physical
quintile
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Outcome_Physical
Anemia
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Outcome_Physical
Hemoglobin
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Outcome_Physical
RESULTS Hemoglobin
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Outcome_Mortality
of all-cause mortality or all-cause hospitalization
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Outcome_Mortality
of all-cause mortality alone
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Outcome_Mortality
cardiovascular ( CV ) mortality
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Outcome_Physical
CV hospitalization
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Outcome_Mortality
CV mortality
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Outcome_Physical
HF hospitalization
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Outcome_Other
0.001
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Outcome_Physical
Heart failure hospitalizations
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Outcome_Physical
urgent outpatient visits
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Outcome_Physical
HF exacerbations
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Outcome_Mortality
all-cause mortality or hospitalization
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Outcome_Physical
adjusted HR
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Outcome_Mortality
0.38 )
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Outcome_Mortality
CV death
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Outcome_Physical
CV hospitalization
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Outcome_Physical
HF hospitalization
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Participant_Condition
patients with heart failure due to reduced left ventricular systolic function .
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Participant_Condition
patients with heart failure ( HF ) due to reduced left ventricular ejection fraction ( HFREF
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Participant_Condition
HFREF
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Participant_Condition
patients with heart failure
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Participant_Sample-size
2331 patients
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Participant_Condition
HFREF
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Participant_Condition
Patients with New York Heart Association class II to IV HF
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Participant_Condition
left ventricular ejection fractions of ≤ 35 %
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Participant_Sex
men
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Participant_Sex
women
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Participant_Sample-size
1763
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Participant_Age
their median age was 59.0 years ,
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Participant_Sex
male
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Participant_Condition
in patients with chronic HFREF