Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis
Por:
Berry, C, Poppe, KK, Gamble, GD, Earle, NJ, Ezekowitz, JA, Squire, IB, McMurray, JJV, McAlister, FA, Komajda, M, Swedberg, K, Maggioni, AP, Ahmed, A, Whalley, GA, Doughty, RN, Tarantini, L, Puig T., Gude Sampedro, Francisco
Publicada:
1 jun 2016
Resumen:
Background: Anaemia is common among patients with heart failure (HF) and is an important prognostic marker.
Aim: We sought to determine the prognostic importance of anaemia in a large multinational pooled dataset of prospectively enrolled HF patients, with the specific aim to determine the prognostic role of anaemia in HF with preserved and reduced ejection fraction (HF-PEF and HF-REF, respectively).
Design: Individual person data meta-analysis.
Methods: Patients with haemoglobin (Hb) data from the MAGGIC dataset were used. Anaemia was defined as Hb < 120 g/l in women and < 130 g/l in men. HF-PEF was defined as EF >= 50%; HF-REF was EF < 50%. Cox proportional hazard modelling, with adjustment for clinically relevant variables, was undertaken to investigate factors associated with 3-year all-cause mortality.
Results: Thirteen thousand two hundred and ninety-five patients with HF from 19 studies (9887 with HF-REF and 3408 with HF-PEF). The prevalence of anaemia was similar among those with HF-REF and HF-PEF (42.8 and 41.6% respectively). Compared with patients with normal Hb values, those with anaemia were older, were more likely to have diabetes, ischaemic aetiology, New York Heart Association class IV symptoms, lower estimated glomerular filtration rate and were more likely to be taking diuretic and less likely to be taking a beta-blocker. Patients with anaemia had higher all-cause mortality (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.25-1.51), independent of EF group: aHR 1.67 (1.39-1.99) in HF-PEF and aHR 2.49 (2.13-2.90) in HF-REF.
Conclusions: Anaemia is an adverse prognostic factor in HF irrespective of EF. The prognostic importance of anaemia was greatest in patients with HF-REF.
Filiaciones:
Berry, C:
Univ Glasgow, Inst Cardiovasc & Med Sci, BHF Glasgow Cardiovasc Res Ctr, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland
Poppe, KK:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Gamble, GD:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Earle, NJ:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Ezekowitz, JA:
Univ Alberta, Div Cardiol, Edmonton, AB, Canada
Squire, IB:
Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
Glenfield Hosp, NIHR Leicester Cardiovasc Biomed Res Unit, Leicester, Leics, England
McMurray, JJV:
Univ Glasgow, Inst Cardiovasc & Med Sci, BHF Glasgow Cardiovasc Res Ctr, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland
McAlister, FA:
Univ Alberta, Div Cardiol, Edmonton, AB, Canada
Komajda, M:
Univ Paris 06, Dept Cardiol, Paris, France
Hop La Pitie Salpetriere, Paris, France
Swedberg, K:
Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden
Imperial Coll, Natl Heart & Lung Inst, London, England
Maggioni, AP:
ANMCO Res Ctr, Florence, Italy
Ahmed, A:
Univ Alabama Birmingham, Div Cardiovasc Dis, Birmingham, AL USA
Vet Affairs Med Ctr, Birmingham, AL USA
Whalley, GA:
Unitec Inst Technol, Fac Social & Hlth Sci, Auckland, New Zealand
Doughty, RN:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Tarantini, L:
Osped San Martino Genova, Heart Failure Unit, Dept Cardiol, Genoa, Italy
Puig T.:
Institut dInvestigació Biomèdica Sant Pau IIB Sant Pau, Barceona, Spain
Gude Sampedro, Francisco :
Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
Green Accepted, Green Published, Bronze
|