Anemia, Mortality, and Hospitalizations in Heart Failure With a Preserved Ejection Fraction (from the TOPCAT Trial)

Kartik Gupta, Rajat Kalra, Indranee Rajapreyar, Joanna M. Joly, Mike Pate, Marc G. Cribbs, Sameer Ather, Sumanth D. Prabhu, Navkaranbir S. Bajaj

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14 Scopus citations


In this post-hoc analysis of the TOPCAT trial, we evaluated the prognostic role of anemia in adverse cardiovascular (CV) outcomes in heart failure with a preserved ejection fraction (HFpEF). Anemia was defined as hemoglobin of <12 g/dl in females and <13 g/dl in males. The primary outcome was a composite of CV mortality, aborted cardiac arrest (ACA), and heart failure (HF) hospitalization. Secondary outcomes were components of the primary outcome, all-cause, CV and non-CV mortality, cause-specific CV and non-CV mortality, all-cause and HF hospitalization, myocardial infarction, and stroke. Among 1,748 patients from TOPCAT-Americas, patients with anemia had a 52% higher risk of the primary outcome (hazard ratio [HR] 1.52, 95% confidence interval 1.27, 1.83, p<0.05) during a median follow up of 2.4 years. These patients were also at higher risk of all-cause and CV mortality with no difference in non-CV mortality. Among CV causes, patients with anemia had higher risk of sudden cardiac death (SCD)/ACA and presumed CV death with no difference in death due to pump failure. Among non-CV causes, patients with anemia had higher risk of death due to malignancy (HR 2.61, p<0.05). Patients with anemia had higher risk of all-cause and HF hospitalizations (HR 1.26 and 1.56, respectively, p<0.05 for both). There was no difference in the risk of myocardial infarction or stroke. In conclusion, patients with HFpEF and anemia are at higher risk of mortality and hospitalization. Anemia is a significant risk factor for SCD/ACA, death due to presumed CV causes and malignancy in HFpEF.

Original languageEnglish (US)
Pages (from-to)1347-1354
Number of pages8
JournalAmerican Journal of Cardiology
Issue number9
StatePublished - May 1 2020

Bibliographical note

Funding Information:
Funding: Dr. Bajaj is supported by Walter B. Frommeyer, Jr. Fellowship in Investigative Medicine awarded by the University of Alabama at Birmingham, American College of Cardiology Presidential Career Development Award and National Center for Advancing Translational Research of the National Institutes of Health under award number UL1TR001417. Dr. Prabhu is supported by NIH R01 grants HL125735 and HL147549, and a VA Merit Award I01 BX002706.

Publisher Copyright:
© 2020

Copyright 2020 Elsevier B.V., All rights reserved.


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