Clinical Profile and Prognostic Value of Anemia at the Time of Admission and Discharge Among Patients Hospitalized for Heart Failure with Reduced Ejection Fraction: Findings from the EVEREST Trial
Background—Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and post-discharge outcomes of hospitalized HF (HHF) patients with anemia at admission and/or discharge.
Methods and Results—An analysis was performed on 3731/4133 (90%) of HHF patients with ejection fraction <40% enrolled in the EVEREST trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes [all-cause mortality (ACM) and cardiovascular mortality (CVM) or HF hospitalization] of patients with and without anemia (hemoglobin <12g/dL for females and <13g/dL for males) on admission and/or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge/day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared to those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission was independently associated with increased ACM (Hazard Ratio [HR] 1.30; 95% Confidence Interval [CI], 1.05-1.60, P=0.015; and HR 0.94; 95% CI, 0.76-1.15, P=0.53, respectively) and CVM+HF hospitalization early post-discharge (≤100 days) (HR 1.73; 95% CI, 1.37-2.18, P=<0.001; and HR 0.92; 95% CI, 0.73-1.16, P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term CVM+HF hospitalization (>100 days) on adjusted analysis (both P>0.1).
Conclusions—Among HHF patients with reduced EF, modest anemia at discharge but not baseline was associated with increased ACM and short-term CVM+HF hospitalization.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
- Received September 16, 2013.
- Accepted April 9, 2014.