Renal insufficiency and anemia are increasingly recognized as predictors of adverse
events in heart failure. The impact of blood transfusion on mortality in patients
with heart failure has not been previously characterized. We examined temporal changes
in admissions and in-hospital mortality using public discharge data from California
(2000 to 2006) and then evaluated the impact of renal insufficiency, anemia, and transfusion
on in-hospital mortality in univariate and multivariate analyses. In total 596,456
unique patient admissions for heart failure were recorded. Renal insufficiency and
anemia were common co-morbidities (27.4% and 27.1%, respectively) and 6.2% of patients
received a transfusion of red blood cells. Renal insufficiency and anemia were associated
with increased mortality (unadjusted odds ratio [OR] 2.45, 95% confidence interval
[CI] 2.39 to 2.52, and 1.27, 95% CI 1.24 to 1.30, respectively). After adjustment,
renal insufficiency (OR 2.54, 95% CI 2.46 to 2.62) and anemia (OR 1.12 95% CI 1.07
to 1.17) remained significant; however, transfusion emerged as the strongest single
predictor (OR 3.81, 95% CI 3.51 to 4.13) of mortality. In conclusion, these data suggest
that anemia and renal insufficiency are independently associated with mortality in
an unselected heart failure population. This is the first study to demonstrate that
transfusion magnifies this effect and is associated with a particularly poor prognosis.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics—2010 Update.American Heart Association, Dallas, TX2010 (Accessed: February 26, 2010)
- Anemia: the point of convergence or divergence for kidney disease and heart failure?.J Am Coll Cardiol. 2009; 53: 639-647
- Cardiorenal syndrome.J Am Coll Cardiol. 2008; 52: 1527-1539
- Quality of care and outcomes among patients with heart failure and chronic kidney disease: a Get With the Guidelines–Heart Failure Program study.Am Heart J. 2008; 156: 674-681
- Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J. 2007; 153: 1021-1028
- Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database.J Am Coll Cardiol. 2006; 47: 76-84
- Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (Insight from the OPTIMIZE-HF Registry).Am J Cardiol. 2008; 101: 223-230
- Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).J Am Coll Cardiol. 2008; 29: 347-356
- Impact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population.J Card Fail. 2004; 10: 467-471
- California Census Data.(Accessed: February 13, 2010)
- Blood transfusion for acute decompensated heart failure—friend or foe?.Am Heart J. 2009; 158: 653-658
- Ferric carboxymaltose in patients with heart failure and iron deficiency.N Engl J Med. 2009; 361: 2436-2448
- Erythropoiesis-stimulating agents—time for a reevaluation.N Engl J Med. 2010; 362: 189-192
- High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database.J Card Fail. 2007; 13: 422-430
- Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J. 2005; 149: 209-216
- Value of blood transfusion in patients with a blood hematocrit of 24% to 30% after percutaneous coronary intervention.Am J Cardiol. 2009; 104: 1069-1073
- Anemia and mortality in heart failure patients a systematic review and meta-analysis.J Am Coll Cardiol. 2008; 52: 818-827
- Anemia and heart failure: a community study.Am J Med. 2008; 121: 726-732
- Emerging role of anemia in heart failure.Am J Cardiol. 2007; 99: 15D-20D
- Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure.J Am Coll Cardiol. 2002; 39: 1780-1786
- Anemia and chronic kidney disease are associated with poor outcomes in heart failure patients.BMC Nephrol. 2006; 7: 3
- Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population based study.J Am Soc Nephrol. 2002; 13: 1928-1936
- Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure.Circulation. 2003; 107: 223-225
- Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure.J Am Coll Cardiol. 2008; 51: 569-576
- Aggressive therapy of congestive heart failure and associated chronic renal failure with medications and correction of anemia stops or slows the progression of both diseases.Perit Dial Int. 2001; 21: S236-S240
- The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron.Nephrol Dial Transplant. 2003; 18: 141-146
- The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.N Engl J Med. 1998; 339: 584-590
- A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario.Am Heart J. 2002; 144: 290-296
Article Info
Publication History
Accepted:
August 24,
2010
Received in revised form:
August 24,
2010
Received:
June 12,
2010
Footnotes
Dr. Krantz has received investigator-initiated research grant support from GlaxoSmithKline , Brentford, Middlesex, United Kingdom and receives funding through the National Heart, Lung, and Blood Institute , Bethesda, Maryland.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
