Department of Cardiovascular Medicine, St. John Providence Health System, Warren, St. John Hospital and Medical Center, Detroit, St. John Hospital Macomb Oakland Center, Madison Heights, Providence Hospitals and Medical Centers, Southfield and Novi, and Providence Park Heart Institute, Novi, Michigan.
Clin Cardiol. 2013 Oct;36(10):611-20. doi: 10.1002/clc.22181. Epub 2013 Aug 8.
Anemia is associated with decreased functional capacity, reduced quality of life, and worsened outcomes among patients with heart failure (HF) due to reduced left ventricular ejection fraction (HFREF). We sought to evaluate the independent effect of anemia on clinical outcomes among those with HFREF.
Anemia is associated with cardiovascular events in patients with heart failure.
The HF-ACTION trial was a prospective, randomized trial of exercise therapy vs usual care in 2331 patients with HFREF. Patients with New York Heart Association class II to IV HF and left ventricular ejection fractions of ≤ 35% were recruited. Hemoglobin (Hb) was measured up to 1 year prior to entry and was stratified by quintile. Anemia was defined as baseline Hb <13 g/dL and <12 g/dL in men and women, respectively. Hemoglobin was assessed in 2 models: a global prediction model that had been previously developed, and a modified model including variables associated with anemia and the studied outcomes.
Hemoglobin was available at baseline in 1763 subjects (76% of total study population); their median age was 59.0 years, 73% were male, and 62% were Caucasian. The prevalence of anemia was 515/1763 (29%). Older age, female sex, African American race, diabetes, hypertension, and lower estimated glomerular filtration rates were all more frequent in lower Hb quintiles. Over a median follow-up of 30 months, the primary outcome of all-cause mortality or all-cause hospitalization occurred in 78% of those with anemia and 64% in those without (P < 0.001). The secondary outcomes of all-cause mortality alone,cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization occurred in 23% vs 15%, 67% vs 54%, and 44 vs 29%, respectively (P < 0.001). Heart failure hospitalizations occurred in 36% vs 22%, and urgent outpatient visits for HF exacerbations occurred in 67% and 55%, respectively (P < 0.001). For the global model, there was an association observed for anemia and all-cause mortality or hospitalization (adjusted hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.01-1.32, P = 0.04), but other outcomes were not significant at P < 0.05. In the modified model, the adjusted HR for anemia and the primary outcome of all-cause mortality or all-cause hospitalization was 1.25 (95% CI: 1.10-1.42, P < 0.001). There were independent associations between anemia and all-cause death (HR: 1.11, 95% CI: 0.87-1.42, P = 0.38), CV death or CV hospitalization (HR: 1.16, 95% CI: 1.01-1.33, P = 0.035), and CV death and HF hospitalization (HR: 1.27, 95% CI: 1.06-1.51, P = 0.008).
Anemia modestly is associated with increased rates of death, hospitalization, and HF exacerbation in patients with chronic HFREF. After adjusting for other important covariates, anemia is independently associated with an excess hazard for all-cause mortality and all-cause hospitalization. Anemia is also associated with combinations of CV death and CV/HF hospitalizations as composite endpoints.
由于左心室射血分数降低，心力衰竭（HF）患者的贫血与功能能力下降、生活质量降低和预后恶化有关。我们旨在评估贫血对 HFREF 患者临床结局的独立影响。
贫血与心力衰竭患者的心血管事件有关。
HF-ACTION 试验是一项前瞻性、随机试验，比较了运动疗法与常规治疗在 2331 例 HFREF 患者中的疗效。入选患者 NYHA 心功能 II 至 IV 级，左心室射血分数≤35%。在入组前最多 1 年测量血红蛋白（Hb），并按五分位数分层。贫血定义为基线 Hb<13g/dL 和男性和女性分别为<12g/dL。血红蛋白在 2 个模型中进行评估：一个是之前开发的全局预测模型，另一个是包括与贫血和研究结局相关的变量的改良模型。
1763 名患者（总研究人群的 76%）在基线时有血红蛋白数据；他们的中位年龄为 59.0 岁，73%为男性，62%为白种人。贫血的患病率为 515/1763（29%）。较低的 Hb 五分位数更常见于年龄较大、女性、非裔美国人、糖尿病、高血压和较低的估计肾小球滤过率。在中位随访 30 个月期间，所有原因死亡或全因住院的主要结局发生在贫血患者中的比例为 78%，而非贫血患者中的比例为 64%（P<0.001）。全因死亡率、心血管（CV）死亡率或 CV 住院、CV 死亡率或 HF 住院的次要结局分别发生在 23%、67%、44%和 44%（P<0.001）。心力衰竭住院的发生率为 36%，HF 恶化的紧急门诊就诊率分别为 67%和 55%（P<0.001）。对于全局模型，贫血与全因死亡率或住院相关（调整后的危险比[HR]：1.15，95%置信区间[CI]：1.01-1.32，P=0.04），但其他结局在 P<0.05 时并不显著。在改良模型中，贫血与全因死亡率或全因住院的主要结局的调整 HR 为 1.25（95%CI：1.10-1.42，P<0.001）。贫血与全因死亡（HR：1.11，95%CI：0.87-1.42，P=0.38）、CV 死亡或 CV 住院（HR：1.16，95%CI：1.01-1.33，P=0.035）和 CV 死亡和 HF 住院（HR：1.27，95%CI：1.06-1.51，P=0.008）独立相关。
贫血与慢性 HFREF 患者的死亡率、住院率和 HF 恶化率轻度相关。在调整其他重要协变量后，贫血与全因死亡率和全因住院率的超额危险独立相关。贫血还与 CV 死亡和 CV/HF 住院的组合终点相关。
