Hemoglobin Kinetics and Long-term Prognosis in Heart Failure

Introduction and objectives: The influence of hemoglobin kinetics on outcomes in heart failure has been incompletely established. Methods: Hemoglobin was determined at the first visit and at 6 months. Anemia was defined according to World Health Organization criteria (hemoglobin < 13 g/dL for men and hemoglobin < 12 g/dL for women). Patients were classified relative to their hemoglobin values as nonanemic (both measurements normal), transiently anemic (anemic at the first visit but not at 6 months), newly anemic (nonanemic initially but anemic at 6 months), or permanently anemic (anemic in both measurements). Results: A total of 1173 consecutive patients (71.9% men, mean age 66.8 +/- 12.2 years) were included in the study. In all, 476 patients (40.6%) were considered nonanemic, 170 (14.5%) had transient anemia, 147 (12.5%) developed new-onset anemia, and 380 (32.4%) were persistently anemic. During a follow-up of 3.7 +/- 2.8 years after the 6-month visit, 494 patients died. On comprehensive multivariable analyses, anemia (P <.001) and the type of anemia (P <.001) remained as independent predictors of all-cause mortality. Compared with patients without anemia, patients with persistent anemia (hazard ratio [HR] = 1.62; 95% confidence interval [95% CI], 1.30-2.03; P <.001) and new-onset anemia (HR = 1.39; 95% CI, 1.04-1.87, P =.03) had higher mortality, and even transient anemia showed a similar trend, although without reaching statistical significance (HR = 1.31; 95% CI, 0.97-1.77, P =.075). Conclusions: Anemia, especially persistent and of new-onset, and to a lesser degree, transient anemia, is deleterious in heart failure. (C) 2016 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.