Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 1;5(4):361-369.
doi: 10.1093/ehjqcco/qcz010.

Incident anaemia in older adults with heart failure: rate, aetiology, and association with outcomes

Andrew P Ambrosy  1   2 , Jerry H Gurwitz  3   4 , Grace H Tabada  2 , Andrew Artz  5 , Stanley Schrier  6 , Sunil V Rao  7   8 , Huiman X Barnhart  8 , Kristi Reynolds  9 , David H Smith  10 , Pamela N Peterson  11   12   13 , Sue Hee Sung  2 , Harvey Jay Cohen  14 , Alan S Go  2   15   16 ; RBC HEART Investigators
Affiliations

Incident anaemia in older adults with heart failure: rate, aetiology, and association with outcomes

Andrew P Ambrosy et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia, and to evaluate the independent association between incident anaemia 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 and 2012 and no anaemia at entry. Incident anaemia was defined using World Health Organization (WHO) haemoglobin 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 anaemia 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 anaemia was 26.4 (95% CI 26.0-26.7) and was higher for preserved ejection fraction (EF) [29.2 (95% CI 28.6-29.8)] compared with borderline EF [26.5 (95% CI 25.4-27.7)] or reduced EF [26.6 (95% CI 25.8-27.4)]. Iron indices, vitamin B12 level, and thyroid testing were performed in 20.9%, 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 anaemia was associated with excess mortality [hazard ratio (HR) 2.14, 95% CI 2.07-2.22] as well as hospitalization for HF (HR 1.80, 95% CI 1.72-1.88) and any cause (HR 1.77, 95% CI 1.72-1.83).

Conclusion: Among older adults with HF, incident anaemia 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 anaemia.

Keywords: Anaemia; Ejection fraction; Heart failure; Iron deficiency; Outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A consort diagram showing the derivation of the final analytic cohort of older adults with heart failure.
Figure 2
Figure 2
Multivariable association of incident anaemia and anaemia type with (A) all-cause mortality, (B) all-cause hospitalization, and (C) heart failure-specific hospitalization based on status and underlying aetiology of incident anaemia. The reference group was no incident anaemia in all models.
See this image and copyright information in PMC

References

    1. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC.. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004;104:2263–2268. - PubMed
    1. Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM. et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: outcomes and Resource Utilization (ANCHOR) study. Circulation 2006;113:2713–2723. - PubMed
    1. Tang WH, Tong W, Jain A, Francis GS, Harris CM, Young JB.. 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. - PubMed
    1. Komajda M, Anker SD, Charlesworth A, Okonko D, Metra M, Di Lenarda A. et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006;27:1440–1446. - PubMed
    1. Ishani A, Weinhandl E, Zhao Z, Gilbertson DT, Collins AJ, Yusuf S. et al. Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2005;45:391–399. - PubMed

Publication types