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Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum
Karolinska Inst, Sweden.
Cty Hosp Ryhov, Sweden.
Linköping University, Department of Computer and Information Science, The Division of Statistics and Machine Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
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2020 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 298, p. 59-65Article in journal (Refereed) Published
Abstract [en]

Background: The role of anemia in heart failure with mid-range and preserved ejection fraction (HFmrEF, EF 40-49% and HFpEF, EF amp;gt;= 50%) is unknown. We aimed to compare prevalence of, associations with, and prognostic role of anemia in HF across the EF spectrum. Methods: In patients from the Swedish HF Registry, we assessed the associations between clinical characteristics and anemia (hemoglobin amp;lt;120 g/L in women and amp;lt;130 g/L in men) by multivariable logistic regression, and between anemia, composite of all-cause death and HF hospitalization and all-cause death alone by multivariable Cox regression. Results: Of 49,985 patients with HF (anemia = 34%), 23% had HFpEF (anemia = 41%), 21% had HFmrEF (anemia = 35%) and 55% had HFpEF (anemia = 32%). Higher EF was independently associated with higher likelihood of concomitant anemia. Important predictors of anemia across the EF spectrum were male sex, older age, worse New York Heart Association class and renal function, lower systolic blood pressure, higher N-Terminal B-type natriuretic peptides levels, diabetes, valvular disease and in-patient status. Anemia had adjusted hazard ratios (95% CI) for mortality or HF hospitalization 1.24 (1.18-1.30) in HFpEF, 1.26 (1.19-1.34) in HFmrEF and 1.14 (1.10-1.19) in HFrEF; p(interaction)EF = 0.003; and for mortality 1.28 (1.20-1.36) in HFpEF, 1.21 (1.13-1.29) in HFmrEF, and 1.30 (1.24-1.35) in HFrEF; p(interaction)EF = 0.22. Conclusions: In this nation-wide registry, prevalence of anemia was higher in HFpEF vs. HFmrEF vs. HFrEF, but was associated with a similarly increased risk of death across the EF spectrum, with greater risk of death or HF hospitalization in HFpEF and HFmrEF vs. HFrEF. (C) 2019 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2020. Vol. 298, p. 59-65
Keywords [en]
Heart failure; Mid-range ejection fraction; Preserved ejection fraction; Anemia; Outcomes; Registry
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-163103DOI: 10.1016/j.ijcard.2019.08.049ISI: 000505040600016PubMedID: 31521440OAI: oai:DiVA.org:liu-163103DiVA, id: diva2:1385079
Note

Funding Agencies|Swedish National Board of Health andWelfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; Linkoping University [LIO 19211]; Swedish HF Registry foundation

Available from: 2020-01-13 Created: 2020-01-13 Last updated: 2020-01-13

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Hallberg, Ann-CharlotteDahlström, Ulf
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The Division of Statistics and Machine LearningFaculty of Arts and SciencesDivision of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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International Journal of Cardiology
Cardiac and Cardiovascular Systems

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