Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure : Results of the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program

• Published in: Circulation (New York, N.Y.) Vol. 113; no. 7; pp. 986 - 994
• Main Authors: O'MEARA, Eileen, CLAYTON, Tim, OLOFSSON, Bertil, MICHELSON, Eric L, POCOCK, Stuart, YUSUF, Salim, SWEDBERG, Karl, PFEFFER, Marc A, MCENTEGART, Margaret B, MCMURRAY, John J. V, LANG, Chim C, ROGER, Simon D, YOUNG, James B, SOLOMON, Scott D, GRANGER, Christopher B, ÖSTERGREN, Jan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21-02-2006
• Subjects: Aged; Anemia - epidemiology; Anemia - etiology; Anemia - mortality; Anemia/epidemiology/etiology/mortality; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Benzimidazoles - pharmacology; Biological and medical sciences; Blood and lymphatic vessels; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Cardiovascular system; Congestive/complications/epidemiology/mortality; Continental Population Groups; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerular Filtration Rate; Heart Failure; Heart Failure - complications; Heart Failure - epidemiology; Heart Failure - mortality; Hemoglobins - analysis; Hospitalization; Humans; Intensive care medicine; Kardiologi; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Multivariate Analysis; Pharmacology. Drug treatments; Prevalence; Risk Factors; Stroke Volume; Tetrazoles - pharmacology; Treatment Outcome; Vasodilator agents. Cerebral vasodilators; Human; Heart failure; Tetrazole derivatives; Anemia; Candesartan; Mortality; Peptide hormone; Cardiovascular disease; Hemopathy; AT1 angiotensin receptor; Morbidity; hemoglobin; kidney; Octapeptide; Renin angiotensin system; Benzimidazole derivatives; Biphenyl derivatives; Heart disease; Antihypertensive agent; Angiotensin antagonist; Angiotensin II
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.582577

We wished to determine the prevalence of, potential mechanistic associations of, and clinical outcomes related to anemia in patients with heart failure and a broad spectrum of left ventricular ejection fraction (LVEF).
In multivariable analyses, we examined the associations between hemoglobin and baseline characteristics, laboratory variables, and outcomes in 2653 patients randomized in the CHARM Program in the United States and Canada. Anemia was equally common in patients with preserved (27%) and reduced (25%) LVEF but was more common in black and older patients. Anemia was associated with ethnicity, diabetes, low body mass index, higher systolic and lower diastolic blood pressure, and recent heart failure hospitalization. More than 50% of anemic patients had a glomerular filtration rate <60 mL.min(-1).1.73 m(-2) compared with <30% of nonanemic patients. Despite an inverse relationship between hemoglobin and LVEF, anemia was associated with an increased risk of death and hospitalization, a relationship observed in patients with both reduced and preserved LVEF. There were 133 versus 69 deaths and 527 versus 352 hospitalizations per 1000 patient-years of follow-up in anemic versus nonanemic patients (both P<0.001). The effect of candesartan in reducing outcomes was independent of hemoglobin.
Anemia was common in heart failure, regardless of LVEF. Lower hemoglobin was associated with higher LVEF yet was an independent predictor of adverse mortality and morbidity outcomes. In heart failure, the causes of anemia and the associations between anemia and outcomes are probably multiple and complex.