Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: Results from Val-HeFT

Inder S. Anand, Michael A. Kuskowski, Thomas S. Rector, Viorel G. Florea, Robert D. Glazer, Allen Hester, Yann Tong Chiang, Nora Aknay, Aldo P. Maggioni, Cristina Opasich, Roberto Latini, Jay N. Cohn

Research output: Contribution to journalArticle

207 Citations (Scopus)

Abstract

Background - Anemia is known to be a prognostic marker for patients with heart failure. However, little is known about the prognostic value of changes in hemoglobin (Hgb) over time or about the causes of anemia. Methods and Results - Retrospective analysis of Valsartan Heart Failure Trial data indicated that the quartile of patients with the biggest average decrease in Hgb over 12 months (from 14.2 to 12.6 g/dL) had significantly (P≤0.01) increased risk of subsequent hospitalization (hazard ratio [HR], 1.47), morbid events (HR, 1.41), and death (HR, 1.6) compared with the quartile that exhibited little change in Hgb over 12 months (from 13.7 to 13.8 g/dL). Increasing Hgb was significantly associated with lower mortality in patients with (HR, 0.78) and without (HR, 0.79) anemia at baseline. Anemia at baseline and the changes in Hgb were independently associated with serum albumin, blood pressure, glomerular filtration rate, B-type natriuretic peptide, and C-reactive protein. Lack of anemia at baseline and increases in Hgb over 12 months were not associated with smaller left ventricular diameters or higher ejection fractions. Conclusions - Changes in Hgb over 12 months were inversely associated with subsequent risk of mortality and morbidity, independently of the effects of baseline anemia and other important predictors. Several factors were independently related to anemia at baseline and changes in Hgb, suggesting multiple causes of anemia in patients with heart failure. These findings raise important questions about the optimal level of Hgb in patients with moderate to severe heart failure and how to achieve them.

Original languageEnglish (US)
Pages (from-to)1121-1127
Number of pages7
JournalCirculation
Volume112
Issue number8
DOIs
StatePublished - Aug 23 2005

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Anemia
Hemoglobins
Heart Failure
Morbidity
Mortality
Valsartan
Brain Natriuretic Peptide
Glomerular Filtration Rate
Serum Albumin
C-Reactive Protein
Hospitalization
Blood Pressure

Keywords

  • Anemia
  • Angiotensin receptor blockers
  • Hemoglobin
  • Natriuretic peptides
  • Prognosis

Cite this

Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure : Results from Val-HeFT. / Anand, Inder S.; Kuskowski, Michael A.; Rector, Thomas S.; Florea, Viorel G.; Glazer, Robert D.; Hester, Allen; Chiang, Yann Tong; Aknay, Nora; Maggioni, Aldo P.; Opasich, Cristina; Latini, Roberto; Cohn, Jay N.

In: Circulation, Vol. 112, No. 8, 23.08.2005, p. 1121-1127.

Research output: Contribution to journalArticle

Anand, Inder S. ; Kuskowski, Michael A. ; Rector, Thomas S. ; Florea, Viorel G. ; Glazer, Robert D. ; Hester, Allen ; Chiang, Yann Tong ; Aknay, Nora ; Maggioni, Aldo P. ; Opasich, Cristina ; Latini, Roberto ; Cohn, Jay N. / Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure : Results from Val-HeFT. In: Circulation. 2005 ; Vol. 112, No. 8. pp. 1121-1127.
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abstract = "Background - Anemia is known to be a prognostic marker for patients with heart failure. However, little is known about the prognostic value of changes in hemoglobin (Hgb) over time or about the causes of anemia. Methods and Results - Retrospective analysis of Valsartan Heart Failure Trial data indicated that the quartile of patients with the biggest average decrease in Hgb over 12 months (from 14.2 to 12.6 g/dL) had significantly (P≤0.01) increased risk of subsequent hospitalization (hazard ratio [HR], 1.47), morbid events (HR, 1.41), and death (HR, 1.6) compared with the quartile that exhibited little change in Hgb over 12 months (from 13.7 to 13.8 g/dL). Increasing Hgb was significantly associated with lower mortality in patients with (HR, 0.78) and without (HR, 0.79) anemia at baseline. Anemia at baseline and the changes in Hgb were independently associated with serum albumin, blood pressure, glomerular filtration rate, B-type natriuretic peptide, and C-reactive protein. Lack of anemia at baseline and increases in Hgb over 12 months were not associated with smaller left ventricular diameters or higher ejection fractions. Conclusions - Changes in Hgb over 12 months were inversely associated with subsequent risk of mortality and morbidity, independently of the effects of baseline anemia and other important predictors. Several factors were independently related to anemia at baseline and changes in Hgb, suggesting multiple causes of anemia in patients with heart failure. These findings raise important questions about the optimal level of Hgb in patients with moderate to severe heart failure and how to achieve them.",
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T1 - Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure

T2 - Results from Val-HeFT

AU - Anand, Inder S.

AU - Kuskowski, Michael A.

AU - Rector, Thomas S.

AU - Florea, Viorel G.

AU - Glazer, Robert D.

AU - Hester, Allen

AU - Chiang, Yann Tong

AU - Aknay, Nora

AU - Maggioni, Aldo P.

AU - Opasich, Cristina

AU - Latini, Roberto

AU - Cohn, Jay N.

PY - 2005/8/23

Y1 - 2005/8/23

N2 - Background - Anemia is known to be a prognostic marker for patients with heart failure. However, little is known about the prognostic value of changes in hemoglobin (Hgb) over time or about the causes of anemia. Methods and Results - Retrospective analysis of Valsartan Heart Failure Trial data indicated that the quartile of patients with the biggest average decrease in Hgb over 12 months (from 14.2 to 12.6 g/dL) had significantly (P≤0.01) increased risk of subsequent hospitalization (hazard ratio [HR], 1.47), morbid events (HR, 1.41), and death (HR, 1.6) compared with the quartile that exhibited little change in Hgb over 12 months (from 13.7 to 13.8 g/dL). Increasing Hgb was significantly associated with lower mortality in patients with (HR, 0.78) and without (HR, 0.79) anemia at baseline. Anemia at baseline and the changes in Hgb were independently associated with serum albumin, blood pressure, glomerular filtration rate, B-type natriuretic peptide, and C-reactive protein. Lack of anemia at baseline and increases in Hgb over 12 months were not associated with smaller left ventricular diameters or higher ejection fractions. Conclusions - Changes in Hgb over 12 months were inversely associated with subsequent risk of mortality and morbidity, independently of the effects of baseline anemia and other important predictors. Several factors were independently related to anemia at baseline and changes in Hgb, suggesting multiple causes of anemia in patients with heart failure. These findings raise important questions about the optimal level of Hgb in patients with moderate to severe heart failure and how to achieve them.

AB - Background - Anemia is known to be a prognostic marker for patients with heart failure. However, little is known about the prognostic value of changes in hemoglobin (Hgb) over time or about the causes of anemia. Methods and Results - Retrospective analysis of Valsartan Heart Failure Trial data indicated that the quartile of patients with the biggest average decrease in Hgb over 12 months (from 14.2 to 12.6 g/dL) had significantly (P≤0.01) increased risk of subsequent hospitalization (hazard ratio [HR], 1.47), morbid events (HR, 1.41), and death (HR, 1.6) compared with the quartile that exhibited little change in Hgb over 12 months (from 13.7 to 13.8 g/dL). Increasing Hgb was significantly associated with lower mortality in patients with (HR, 0.78) and without (HR, 0.79) anemia at baseline. Anemia at baseline and the changes in Hgb were independently associated with serum albumin, blood pressure, glomerular filtration rate, B-type natriuretic peptide, and C-reactive protein. Lack of anemia at baseline and increases in Hgb over 12 months were not associated with smaller left ventricular diameters or higher ejection fractions. Conclusions - Changes in Hgb over 12 months were inversely associated with subsequent risk of mortality and morbidity, independently of the effects of baseline anemia and other important predictors. Several factors were independently related to anemia at baseline and changes in Hgb, suggesting multiple causes of anemia in patients with heart failure. These findings raise important questions about the optimal level of Hgb in patients with moderate to severe heart failure and how to achieve them.

KW - Anemia

KW - Angiotensin receptor blockers

KW - Hemoglobin

KW - Natriuretic peptides

KW - Prognosis

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DO - 10.1161/CIRCULATIONAHA.104.512988

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