Anaemia risk factor for death in heart failure

Anaemia increases mortality risk in heart failure (HF) patients across the ejection fraction (EF) spectrum, a recent study has found. The effect appears to be stronger in preserved (HFpEF) and midrange (HFmrEF) than in reduced (HFrEF) EF disease.

Researchers enrolled 49,985 patients with HF. Anaemia was defined as having haemoglobin <120 g/L in women, and <130 g/L in men. Outcomes included the time to all-cause mortality or first HF hospitalization. Thirty-four percent of the population were found to have anaemia.

Majority (55 percent) of the patients had HFrEF, while 23 percent and 21 percent had HFpEF and HFmrEF, respectively. The prevalence rates of anaemia in the respective EF subgroups were 32 percent, 41 percent and 35 percent.

Logistic regression analysis, adjusted for baseline confounders, showed that anaemia was significantly more likely to occur in both HFpEF (odds ratio [OR], 1.55, 95 percent confidence interval [CI], 1.46–1.65) and HFmrEF (OR, 1.24, 95 percent CI, 1.17–1.31) patients than in their HFrEF counterparts.

In turn, anaemia led to worse outcomes in all EF groups. Multivariable Cox regression models found that survival free of hospitalization was significantly lower in HFpEF (adjusted hazard ratio [HR], 1.24, 95 percent CI, 1.18–1.30), HFmrEF (adjusted HR, 1.26, 95 percent CI, 1.19–1.34) and HFrEF (adjusted HR, 1.14, 1.10–1.19) patients with anaemia than their nonanaemic comparators.

The risk of mortality was likewise elevated in anaemic HFpEF (adjusted HR, 1.28, 95 percent CI, 1.20–1.36), HFmrEF (adjusted HR, 1.21, 1.13–1.29) and HFrEF (adjusted HR, 1.30, 1.24–1.35) patients.