Vnitr Lek 2010, 56(5):382-391

The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure

R. Miklík^1,*, M. Felšöci¹, J. Pařenica¹, D. Tomčíková², J. Jarkovský², J. Špinar¹

¹ Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

² Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph.D.

Aim of study:
To evaluate the influence of entry hemoglobin level on the hospitalization mortality of the patients admitted with AHF caused by 4 major etiologies - acute coronary syndrome with ST elevation (STEMI, n = 325) and without ST elevation (nonSTEMI, n = 210), decompensated chronic ischaemic heart disease (IHD, n = 206) and dilated cardiomyopathy (CMP, n = 88).

Results:
We analyzed 1,253 consecutive 1st-time hospitalizations of AHF patients of whom 1,212 had their entry hemoglobin known. Out of these, 829 subjects were of STEMI (1), nonSTEMI (2), IHD (3) and CMP (4) etiology and were included in further analyses. We devided these patients into subgroups according to hemoglobin levels: I - no anemia, II - minor and III - severe anemia. The hospitalization mortality in subgroups (I-II-III) of each etiology was 16.9-24.5-35.3% (1); 12.4-9.8-35.7% (2); 9.0-9.7-18.2% (3); 1.5-21.4-33.3% (4); all etiologies together 12.4-15.0-28.8%, total rate 14.1%. Univariate analysis (χ²) showed significant differencies in hospitalization mortality depending on etiology and hemoglobin level but not type of failure (de novo/decompensation). Other parametres (comorbidities, laboratory and hemodynamic values, medication at entry) had a very variable impact on mortality throughout etiologies and hemoglobin subgroups.

Conclusion:
The presence of anemia increases hospitalization mortality of patients with acute heart failure. The relation between hemoglobin level and mortality seems to be linear, we did not observe "U shape" type of relation. It is necessary to distinguish etiologies of AHF as well as consider effects of laboratory and anamnestic variables when interpreting the results.

Keywords: prevalence; anemia; haemoglobin; acute heart failure; hospitalization mortality

Received: October 2, 2009; Accepted: March 30, 2010; Published: May 1, 2010  Show citation