Document Detail

Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project.
MedLine Citation:
PMID:  16246989     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Recent reports have suggested that anemia is associated with adverse outcomes in patients with heart failure (HF), but were unable to adjust for a broad range of comorbid conditions. As a result, whether anemia is a truly independent predictor of risk or a marker of comorbid illness in these patients is unknown. METHODS: We analyzed medical records from the Centers for Medicare & Medicaid Services' National Heart Care Project, a national sample of 50,405 patients 65 years and older admitted to acute care hospitals with a principal discharge diagnosis of HF between April 1, 1998, and March 31, 1999, or between July 1, 2000, and June 30, 2001. Multivariable logistic regression analyses were conducted to test whether hematocrit level was an independent predictor of all-cause mortality and HF-related readmission at 1 year. RESULTS: In unadjusted analysis, lower hematocrit levels were associated with increased 1-year mortality and readmission for HF. Compared with patients with a hematocrit greater than 40% to 44%, those with a hematocrit of 24% or less had a 51% higher risk of death (relative risk [RR], 1.51; 95% confidence interval [CI], 1.35-1.68; P<.001) and a 17% higher risk of HF-related readmission (RR, 1.17; 95% CI, 1.01-1.34; P = .04). However, after adjustment for multiple comorbidities and other clinical factors, the association between lower hematocrit levels and increased 1-year mortality was markedly attenuated, even in those patients with the most severe anemia (hematocrit, < or = 24% vs > 40%-44%: RR, 1.02; 95% CI, 0.86-1.19; P = .85). The association between lower hematocrit values and HF-related readmission persisted after multivariable adjustment (hematocrit, < or = 24% vs > 40%-44%: RR, 1.21; 95% CI, 1.04-1.38; P = .01). CONCLUSIONS: Although anemia is an independent predictor of hospital readmission, its relationship with increased mortality in HF patients is largely explained by the severity of comorbid illness. These findings suggest that anemia may be predominantly a marker rather than a mediator of increased mortality risk in older patients with HF.
Mikhail Kosiborod; Jeptha P Curtis; Yongfei Wang; Grace L Smith; Frederick A Masoudi; JoAnne M Foody; Edward P Havranek; Harlan M Krumholz
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  165     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-25     Completed Date:  2005-11-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2237-44     Citation Subset:  AIM; IM    
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.
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MeSH Terms
Anemia / blood,  complications,  epidemiology*
Biological Markers / blood
Follow-Up Studies
Heart Failure / complications*,  epidemiology
Hospitalization / statistics & numerical data
Multivariate Analysis
National Health Programs*
Outcome Assessment (Health Care)*
Retrospective Studies
Risk Factors
Survival Rate / trends
United States / epidemiology
Grant Support
K08-AG01011/AG/NIA NIH HHS; K08-AG20623-01/AG/NIA NIH HHS
Reg. No./Substance:
0/Biological Markers
Comment In:
Arch Intern Med. 2005 Oct 24;165(19):2187-9   [PMID:  16246978 ]

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