The prognostic importance of anemia in patients with heart failure

被引:217
作者
Kosiborod, M
Smith, GL
Radford, MJ
Foody, JM
Krumholz, HM
机构
[1] Yale Univ, Yale New Haven Hosp, Sect Cardiovasc Med, Dept Med, New Haven, CT USA
[2] Yale Univ, Yale New Haven Hosp, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT USA
[3] Yale Univ, Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, New Haven, CT USA
[4] Yale Univ, New Haven Hlth, Ctr Outcomes Res & Evaluat, New Haven, CT USA
[5] Qualidigm, Middletown, CT USA
关键词
D O I
10.1016/S0002-9343(02)01498-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: Physiologic studies have suggested that anemia could adversely affect the cardiovascular condition of patients with heart failure. Yet, the prognostic importance of this treatable condition is not well established by epidemiologic studies. We sought to determine the prognostic value of hematocrit level in a cohort of elderly patients hospitalized with heart failure. METHODS: We studied a consecutive sample of 2281 patients aged 65 years or older who had been admitted with a principal discharge diagnosis of heart failure. Multivariate Cox proportional hazards regression was conducted to test whether hematocrit level was an independent predictor of 1-year mortality and of hospital readmission. RESULTS: The mean (+/- SD) age of the patients was 79 8 years; 58% (n = 1324) were women. Their median hematocrit was 38% (25th to 75th percentile, 33% to 42%). Lower hematocrits were associated with a higher mortality. After adjusting for demographic and clinical factors, each 1% lower hematocrit was associated with a 2% greater 1-year mortality (P = 0.007). Compared with patients with a hematocrit >42%, those with a hematocrit less than or equal to27% had a 40% greater 1-year mortality (hazard ratio [HR] = 1.40; 95% confidence interval [CI]: 1.02 to 1.92; P = 0.04). This increased risk was similar to that conferred by traditional risk factors, including a left ventricular ejection fraction : 20% (HR = 1.50; 95% CI: 1.20 to 1.86). Lower hematocrits were also associated with a greater risk of hospital readmission. CONCLUSION: Anemia is associated with an increased risk of death and rehospitalization in older patients with heart failure. Whether anemia is a direct cause of worse outcomes, or a marker for other causal factors, is not known. (C) 2003 by Excerpta Medica Inc.
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页码:112 / 119
页数:8
相关论文
共 47 条
  • [1] Adams KF, 1999, J CARD FAIL, V5, P357
  • [2] Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction
    Al-Ahmad, A
    Rand, WM
    Manjunath, G
    Konstam, MA
    Salem, DN
    Levey, AS
    Sarnak, MJ
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (04) : 955 - 962
  • [3] Congestive heart failure hospitalizations and survival in California: Patterns according to race ethnicity
    Alexander, M
    Grumbach, K
    Remy, L
    Rowell, R
    Massie, BM
    [J]. AMERICAN HEART JOURNAL, 1999, 137 (05) : 919 - 927
  • [4] ANAND IS, 1993, BRIT HEART J, V70, P357
  • [5] Prognosis of congestive heart failure after prior myocardial infarction in older men and women with abnormal versus normal left ventricular ejection fraction
    Aronow, WS
    Ahn, C
    Kronzon, I
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2000, 85 (11) : 1382 - +
  • [6] Beutler E., 1995, Williams hematology
  • [7] BROPHY JM, 1994, CAN J CARDIOL, V10, P543
  • [8] Effect of anaemia and cardiovascular disease on surgical mortality and morbidity
    Carson, JL
    [J]. LANCET, 1996, 348 (9034) : 1055 - 1060
  • [9] A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION
    CHARLSON, ME
    POMPEI, P
    ALES, KL
    MACKENZIE, CR
    [J]. JOURNAL OF CHRONIC DISEASES, 1987, 40 (05): : 373 - 383
  • [10] COHN JN, 1993, CIRCULATION, V87, P5