Abstract
Background
Anemia is a purported risk factor for adverse outcomes, particularly among patients with cardiac disease. Although anemia at the time of discharge has been associated with poor functional status and survival, its impact over time is not clear.
Hypothesis
Among patients with significant coronary artery disease (CAD), anemia (hemoglobin < 11 g/dL) is prevalent, and is associated with poor physical function (PF) and survival over time.
Methods
Patients with significant CAD at the time of cardiac catheterization (n = 1, 821) were enrolled into a single‐center, observational, and prospective study. All patients were followed for up to 1 y for clinical events and self‐reported PF. Prevalence of anemia at discharge and its' associations with outcomes over time were examined.
Results
Anemia at the time of discharge was very common (40.4%), and was associated with increased odds of death at 12 mo (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.12–2.15), yet other clinical factors accompanying anemia accounted for this association (adjusted OR 1.13, 95% CI 0.79–1.62). Discharge anemia was also associated with significantly lower self‐reported PF at 6 and 12 mo (p < 0.05 for both); however, other clinical factors accompanying anemia also accounted for these associations.
Conclusions
Although discharge anemia is highly prevalent, its association with adverse outcomes is largely explained by baseline patient characteristics. Further research is needed to clarify the relationship between anemia and outcomes in this population and to identify subpopulations that do not recover independently and for whom available therapies may be beneficial. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: coronary artery disease, anemia, mortality, physical function
Full Text
The Full Text of this article is available as a PDF (192.6 KB).
References
- 1. Al Falluji N, Lawrence‐Nelson J, Kostis JB, Lacy CR, Ranjan R, et al.: Effect of anemia on 1‐year mortality in patients with acute myocardial infarction. Am Heart J 2002; 144: 636–641. [DOI] [PubMed] [Google Scholar]
- 2. Anand I, McMurray JJ, Whitmore J, Warren M, Pham A, et al.: Anemia and its relationship to clinical outcome in heart failure. Circulation 2004; 110: 149–154. [DOI] [PubMed] [Google Scholar]
- 3. Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, et al.: Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005; 111: 2042–2049. [DOI] [PubMed] [Google Scholar]
- 4. Vaglio J, Safley DM, Rahman M, Kosiborod M, Jones P, et al.: Relation of anemia at discharge to survival after acute coronary syndromes. Am J Cardiol 2005; 96: 496–499. [DOI] [PubMed] [Google Scholar]
- 5. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM: Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001; 345: 1230–1236. [DOI] [PubMed] [Google Scholar]
- 6. Kinnaird TD, Stabile E, Mintz GS, Lee CW, Canols DA, et al.: Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol 2003; 92: 930–935. [DOI] [PubMed] [Google Scholar]
- 7. Moscucci M, Fox KA, Cannon CP, Klein W, Lopez‐Sendon J, et al.: Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003; 24: 1815–1823. [DOI] [PubMed] [Google Scholar]
- 8. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1–266. [PubMed] [Google Scholar]
- 9. Ware JE, Snow KK, Kosisnki M, Gandek B: SF‐36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Center; 1993. [Google Scholar]
- 10. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, et al.: Comparison of methods for the scoring and statistical analysis of SF‐36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 1995; 33: AS264–AS279. [PubMed] [Google Scholar]
- 11. Odden MC, Whooley MA, Shlipak MG: Association of chronic kidney disease and anemia with physical capacity: the heart and soul study. J Am Soc Nephrol 2004; 15: 2908–2915. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Al‐Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, et al.: Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2001; 38: 955–962. [DOI] [PubMed] [Google Scholar]
- 13. Keough‐Ryan TM, Kiberd BA, Dipchand CS, Cox JL, Rose CL, et al.: Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. Am J Kidney Dis 2005; 46: 845–855. [DOI] [PubMed] [Google Scholar]
- 14. McKechnie RS, Smith D, Montoye C, Kline‐Rogers E, O'Donnell MJ, et al.: Prognostic implication of anemia on in‐hospital outcomes after percutaneous coronary intervention. Circulation 2004; 110: 271–277. [DOI] [PubMed] [Google Scholar]
- 15. Cavusoglu E, Chopra V, Gupta A, Clark Lt, Eng C, et al.: Usefulness of anemia in men as an independent predictor of two‐year cardiovascular outcome in patients presenting with acute coronary syndrome. Am J Cardiol 2006; 98: 580–584. [DOI] [PubMed] [Google Scholar]
- 16. Lee PC, Kini AS, Ahsan C, Fisher E, Sharma SK: Anemia is an independent predictor of mortality after percutaneous coronary intervention. J Am Coll Cardiol 2004; 44: 541–546. [DOI] [PubMed] [Google Scholar]
- 17. Ezekowitz JA, McAlister FA, Armstrong PW: Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new‐onset heart failure. Circulation 2003; 107: 223–225. [DOI] [PubMed] [Google Scholar]
- 18. Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, et al.: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006; 355: 2071–2084. [DOI] [PubMed] [Google Scholar]
- 19. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, et al.: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340: 409–417. [DOI] [PubMed] [Google Scholar]
- 20. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, et al.: Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004; 292: 1555–1562. [DOI] [PubMed] [Google Scholar]
- 21. Kosiborod M, Curtis JP, Wang Y, Smith GL, Masoudi FA, et al.: Anemia and outcomes in patients with heart failure: A study from the National Heart Care Project. Arch Intern Med 2005; 165: 2237–2244. [DOI] [PubMed] [Google Scholar]
- 22. Kusek JW, Greene P, Wang SR, Beck G, West D, et al.: Cross‐sectional study of health‐related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial. Am J Kidney Dis 2002; 39: 513–524. [DOI] [PubMed] [Google Scholar]
- 23. Rocco MV, Gassman JJ, Wang SR, Kaplan RM: Cross‐sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study. Am J Kidney Dis 1997; 29: 888–896. [DOI] [PubMed] [Google Scholar]
- 24. Shidler NR, Peterson RA, Kimmel PL: Quality of life and psychosocial relationships in patients with chronic renal insufficiency. Am J Kidney Dis 1998; 32: 557–566. [DOI] [PubMed] [Google Scholar]
- 25. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC: Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004; 104: 2263–2268. [DOI] [PubMed] [Google Scholar]
- 26. Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, et al.: Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006; 48: 2485–2489. [DOI] [PubMed] [Google Scholar]
- 27. Phrommintikul A, Haas SJ, Elsik M, Krum H: Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta‐analysis. Lancet 2007; 369: 381–388. [DOI] [PubMed] [Google Scholar]