Is anemia a predictor of inhospital complications and mortality in decompensated heart failure?

Background

Anemia is a common finding in decompensated heart failure (DHF) and is associated with high mortality rates. Mechanisms for association between these syndromes are unclear and are probably multifactorial.

Objective

To identify contributing factors for anemia and its contribution for a worse prognosis in patients with DHF.

Methods

From January 2003 to December 2004, we studied a cohort of 135 patients (54% male, mean age 76.5 ± 11.08 years, 79.6% NYHA class IV) admitted to the coronary care unit due to DHF. They were divided into three groups (G) according to admission hemoglobin (Hgb) (G1: Hgb >12 g/dl; G2: Hgb = 10–12 g/dl; G3: Hgb <10 g/dl), and baseline demographics, laboratory findings, need of blood transfusion, inhospital complications and mortality were compared. Statistical analyses were performed with the Kruskal–Wallis test (laboratory findings) and Pearson's chi-square test (other variables).

Results

Most of the patients were in G1 (54.1%) (G2 = 37.1%; G3 = 8.8%). Patients in G3 (male 66.6%, P = 0.002) had more previous history of renal dysfunction (41.7%, P = 0.003), higher levels of B-type natriuretic peptide (P = 0.03) and D-dimer (P = 0.001), needed more blood transfusions (66.7% of patients, P < 0.0001) and all patients had at least one complication (P = 0.039). Importantly, inhospital mortality rates were significantly different among groups (G1 = 4.1%, G2 = 3.8%, G3 = 33.3%, P = 0.003).

Conclusions

In DHF, anemia is a strong predictor of inhospital mortality and complications. Increased prevalence of renal dysfunction and necessity of blood transfusion observed in these patients may be related to the mechanisms of higher mortality.