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A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry
County Hospital Ryhov, Sweden.
Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
Karolinska University Hospital, Sweden.
Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 211, 124-131 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background: The aim was to investigate the prevalence of, predictors of, and association with mortality and morbidity of anemia in a large unselected cohort of patients with heart failure (HF) and reduced ejection fraction (HFrEF) and to explore if there were specific subgroups of high risk. Methods: In patients with HFrEF in the Swedish Heart Failure Registry, we assessed hemoglobin levels and associations between baseline characteristics and anemia with logistic regression. Using propensity scores for anemia, we assessed the association between anemia and outcomes with Cox regression, and performed interaction and sub-group analyses. Results: There were 24 511 patients with HFrEF (8303 with anemia). Most important independent predictors of anemia were higher age, male gender and renal dysfunction. One-year survival was 75% with anemia vs. 81% without (p < 0.001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all-cause death 1.34 (1.28-1.40; p < 0.0001), CV mortality 1.28 (1.20-1.36; p < 0.0001), and combined CV mortality or HF hospitalization 1.24 (1.18-1.30; p < 0.0001). In interaction analyses, anemia was associated with greater risk with lower age, male gender, EF 30-39%, and NYHA-class I-II. Conclusion: In HFrEF, anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity. The influence of anemia on mortality was significantly greater in younger patients, in men, and in those with more stable HF. The clinical implication of these findings might be in the future to perform targeted treatment studies. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2016. Vol. 211, 124-131 p.
Keyword [en]
Heart failure; Reduced ejection fraction; Anemia; Outcomes; Observational study
National Category
Mathematics Clinical Medicine
URN: urn:nbn:se:liu:diva-127741DOI: 10.1016/j.ijcard.2016.02.144ISI: 000373918100029PubMedID: 26999301OAI: diva2:927528

Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; Linkoping University; Swedish HF Registry foundation

Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2016-05-12

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Hallberg, Ann-CharlotteDahlström, Ulf
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StatisticsFaculty of Arts and SciencesDivision of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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MathematicsClinical Medicine

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