Spazzafumo Liana, Olivieri Fabiola, Sabbatinelli Jacopo, Galeazzi Roberta, Recchioni Rina, Marcheselli Fiorella, Tamburrini Paola, Antonicelli Roberto
Epidemiologic Observatory, Regional Health Agency, Regione Marche, Ancona, Italy.
Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
J Geriatr Cardiol. 2021 Aug 28;18(8):654-662. doi: 10.11909/j.issn.1671-5411.2021.08.008.
Anemia associated with cardiovascular diseases (CVD) is a common condition in older persons. Prevalence and prognostic role of anemia were extensively studied in patients with myocardial infarction (MI) or congestive heart failure (CHF) whereas limited data were available on patients with atrial fibrillation (AF). This study was conducted to assess the clinical prevalence and prognostic relevance of anemia in elderly patients affected by AF and other CVDs.
A total of 866 elderly patients (430 men and 436 women, age: 65-98 years, mean age: 85 ± 10 years) were enrolled. Among these patients, 267 patients had acute non-ST-segment elevation MI (NSTEMI), 176 patients had acute CHF, 194 patients had acute AF and 229 patients were aged-matched healthy persons (CTR). All parameters were measured at the hospital admission and cardiovascular mortality was assessed during twenty-four months of follow-up.
The prevalence of anemia was higher in NSTEMI, CHF and AF patients compared to CTR subjects (50% 15%, < 0.05), with normocytic anemia being the most prevalent type (90%). Adjusted mortality risk was higher in anemic patient versus non-anemic patient in all the groups of patients [NSTEMI: hazard ratio (HR) = 1.81, 95% CI: 1.06-2.13; CHF: HR = 2.49, 95% CI: 1.31-4.75; AF: HR = 1.98, 95% CI: 1.01-3.88]. Decreased hemoglobin levels ( = 0.001) and high reticulocyte index ( = 0.023) were associated with higher mortality in CVD patients.
The significant associations between CVD and anemia and the prognostic relevance of anemia for elderly patients with CVD were confirmed in this study. The presence of anemia in AF patients is associated with a two-fold increased mortality risk compared with non-anemic AF patients. Low hemoglobin and high reticulocyte count independently predict mortality in elderly patients with CVD.
与心血管疾病（CVD）相关的贫血在老年人中很常见。贫血在心肌梗死（MI）或充血性心力衰竭（CHF）患者中的患病率及预后作用已得到广泛研究，而关于心房颤动（AF）患者的数据有限。本研究旨在评估贫血在老年AF及其他CVD患者中的临床患病率及预后相关性。
共纳入866例老年患者（430例男性和436例女性，年龄65 - 98岁，平均年龄85±10岁）。其中，267例患者患有急性非ST段抬高型心肌梗死（NSTEMI），176例患者患有急性CHF，194例患者患有急性AF，229例患者为年龄匹配的健康人（对照组）。所有参数均在入院时测量，并在24个月的随访期间评估心血管死亡率。
与对照组相比，NSTEMI、CHF和AF患者中贫血的患病率更高（50%对15%，P<0.05），其中正细胞性贫血最为常见（90%）。在所有患者组中，贫血患者的校正死亡风险均高于非贫血患者[NSTEMI：风险比（HR）=1.81，95%置信区间（CI）：1.06 - 2.13；CHF：HR = 2.49，95% CI：1.31 - 4.75；AF：HR = 1.98，95% CI：1.01 - 3.88]。血红蛋白水平降低（P = 0.001）和网织红细胞指数升高（P = 0.023）与CVD患者较高的死亡率相关。
本研究证实了CVD与贫血之间的显著关联以及贫血对老年CVD患者的预后相关性。与非贫血AF患者相比，AF患者中贫血的存在与死亡风险增加两倍相关。低血红蛋白和高网织红细胞计数可独立预测老年CVD患者的死亡率。
