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LM Arcement, R Horswell, R Lee and K Hebert
Chest 128 (4): 292S.
Purpose
Previous studies have shown an association between anemia and mortality in patients with heart failure. One question not addressed is the anemia -mortality relationship within a heart failure population enrolled in a disease management program receiving standard medical therapy including Ace inhibitors and beta blocker medications. Also, the independant effect of anemia on survival has not been well described in a rural indigent population.
Methods
The sample included 328 patients with EF 40% who enrolled in a heart failure disease management program from 1999 to 2003 in rural South Louisiana. Our database was reviewed and a proportional hazards survival model was estimated. Anemia was defined as a hemoglobin of <12g/dl in females and <13 g/dl in males. Terms considered for inclusion into the model were gender, African-American race, age, ejection fraction (< 25% vs. 25-40%), QRS duration, NYHA class (III/IV vs I/II), use of beta blockers, and use of ACE inhibitors.
The prevalence of anemia in this group was 29%. The final model included age (HR=1.04, p=.023), ejection fraction < 25% (HR=2.71, p=.002), African-American race (HR = 1.21, p=.576), and anemia (HR= 2.55, p=.002, 95% CI 1.40 - 4.67). The median annual income was $ 11,300 for both cohorts.
Conclusion
Anemia is common in this cohort. anemia is strongly associated with mortality in a younger rural indigent heart failure population, even when patients are enrolled in a disease management program receiving both Ace inhibitors and beta blockers.
Clinical implications
Identifying this high risk subgroup is important and treating anemia may be considered. Ascertaining the impact of treating anemia in this subgroup must be undertaken in future clinical trials.