Incident Anemia in Older Adults with Heart Failure Rate, Etiology, and Association with Outcomes.
AIMS:Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anemia of the elderly in HF. Thus, we aimed to determine the incidence of anemia, to characterize diagnostic testing patterns for potentially reversible causes of anemia, and to evaluate the independent association between incident anemia and long-term morbidity and mortality. METHODS AND RESULTS:Within the Cardiovascular Research Network (CVRN), we identified adults age ≥65 years with diagnosed HF between 2005-2012 and no anemia at entry. Incident anemia was defined using World Health Organization (WHO) hemoglobin thresholds (<13.0 g/dL in men; <12.0 g/dL in women). All-cause death and hospitalizations for HF and any cause were identified from electronic health records. Among 38,826 older HF patients, 22,163 (57.1%) developed incident anemia over a median (interquartile range) follow-up of 2.9 (1.2, 5.6) years. The crude rate (95% Confidence Interval [CI]) per 100 person-years of incident anemia was 26.4 (CI:26.0-26.7) and was higher for preserved ejection fraction (EF) (29.2 [CI:28.6-29.8]) compared with borderline EF (26.5 [CI: 25.4-27.7]) or reduced EF (26.6 [CI: 25.8-27.4]). Iron indices, vitamin B12 level, and thyroid testing were performed in 21.8%, 14.9% and 40.2% of patients, respectively. Reduced iron stores, vitamin B12 deficiency, and/or hypothyroidism were present in 29.7%, 3.2% and 18.6% of tested patients, respectively. In multivariable analyses, incident anemia was associated with excess mortality (hazard ratio [HR] 2.14, CI:2.07-2.22) as well as hospitalization for HF (HR 1.80, CI:1.72-1.88) and any cause (HR 1.77, CI:1.72-1.83). CONCLUSION:Among older adults with HF, incident anemia is common and independently associated with substantially increased risks of morbidity and mortality. Additional research is necessary to clarify the value of routine evaluation and treatment of potentially reversible causes of anemia.
Ambrosy, AP; Gurwitz, JH; Tabada, GH; Artz, A; Schrier, S; Rao, SV; Barnhart, HX; Reynolds, K; Smith, DH; Peterson, PN; Sung, SH; Cohen, HJ; Go, AS
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