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Rising anemia rates impact HF survival
14 August 2008
MedWire News: Rates of anemia are rising in community patients with heart failure (HF), substantially impacting on their survival, a study suggests.
"Currently, anemia is present in more than half of patients with HF and is considerably more prevalent in those with preserved ejection fraction," the researchers report in the American Journal of Medicine.
The prevalence of anemia was 40% in a retrospective cohort (1979-2002) of 1063 community HF patients and 53% in a prospective cohort of 677 HF patients identified and monitored from 2003 through 2006. Anemia rates rose by 16% between 1979 and 2002 (p=0.008).
"This prevalence is higher than previously reported, likely reflecting the unselected population represented in our community cohorts in contrast with the highly selective nature of trial participants and in studies limited to those with reduced ejection fraction," comment Véronique Roger and colleagues from the Mayo Clinic and Foundation in Rochester, Minnesota, USA.
In the prospective cohort, 58% of patients with preserved left ventricular ejection fraction (LVEF) had anemia, compared with 48% of those with reduced LVEF (p<0.001).
Patients were more likely to die if they had anemia than if they did not, at 41% versus 24%.
Those with hemoglobin levels below 10 mg/dl were 2.39 times more likely to die than those with levels of 14-16 mg/dl. But patients with high levels, of more than 16 mg/dl, also had an increased mortality risk - 3.07 times higher than patients in the reference range (p<0.05 for both).
Pilot studies of treating anemic HF patients with erythropoietin or darbepoetin have reported improved peak oxygen consumption, exercise duration, New York Heart Association functional class, and health-related quality of life in patients given active versus placebo treatment.
Treatment could potentially increase patients' thrombosis risk, however, so a phase III study is currently addressing the risk-benefit balance in patients given active treatment or placebo.
"Given the high burden of anemia in HF, if treatment improves outcomes, the impact could be great," Roger et al conclude.
