ROLE OF IRON DEFICIENCY ANEMIA IN EXACERBATION OF HEART FAILURE IN PATIENTS WITH DILATED CARDIOMYOPATHY

AU REHMAN; K HASSAN; S MEHMOOD; A ASHRAF

doi:10.54112/bcsrj.v2024i1.1415

Authors

AU REHMAN Department Of Cardiology Khyber Teaching Hospital Peshawar Pakistan
K HASSAN District Headquarters Hospital Kda Kohat, Pakistan
S MEHMOOD Department Of Cardiology, Khyber Teaching Hospital Peshawar, Pakistan
A ASHRAF Department Of Cardiology, Khyber Teaching Hospital Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1415

Keywords:

Iron Deficiency Anemia, Heart Failure Exacerbation, Dilated Cardiomyopathy, Cardiac Function, Anemia-Heart Failure Link

Abstract

Patients with heart failure (HF) frequently suffer from anemia. However, there are significant differences in the prevalence, prognostic factor, and clinical impact of anemia in individuals with heart failure. This study shows clinical characteristics and outcomes of severe heart failure patients with anemia who were admitted to Khyber Teaching Hospital Peshawar (KTH) in order to assess the incidence of worsening heart failure in anemic patients. Method: A cross-sectional study was carried out, and we evaluated the medical records of patients with heart failure who were admitted to Khyber Teaching Hospital between August 2023 to January 2024 All HF patients' independent predictors of mortality were examined using multivariate Cox regression. Statistical significance was defined as a P value of less than 0.05.Result: The study included one hundred patients. The study found that 70% of individuals had anemia, and 60% of the participants were female. The levels of salt, creatinine, and hemoglobin in anemic patients differed significantly. Based on hemoglobin level, a more significant difference was seen among research participants (Log rank test, P = 0.001). Additionally, multivariate Cox regression revealed that total mortality was independently predicted by advanced age, lower salt levels, and higher creatinine levels. Conclusion: Heart Failure patients with anemia tend to be older age, had lower hemoglobin and sodium level and higher creatinine value. Moreover, there was a significant difference in the prognosis of anemic Patients, tend to have a worse survival status. Even though, anemia is a significant risk marker, exacerbating heart failure, it is not an independent predictor of mortality in the current study.

Downloads

Download data is not yet available.

References

Stamos TD, Silver MA. Management of anemia in heart failure. Curr Opin Cardiol. 2010;25(2):148–54.

Anand IS. Anemia and chronic heart failure implications and treatment options. J Am Coll Cardiol. 2008;52(7):501–11.

Tomaszuk-Kazberuk A, Bolinska S, Mlodawska E, Lopatowska P, Sobkowicz B, Musial W. Does admission anaemia still predict mortality six years after myocardial infarction? Kardiol Pol. 2014;72(6):488–93.

Young JB, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH, et al. Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol. 2008;101(2):223–30.

Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol. 2008;52(10):818–27.

Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, Drakos SG, et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol. 2006;48(12):2485–9.

Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34(11):816–29.

Kajimoto K, Sato N, Takano T. Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes. Eur Heart J Acute Cardiovasc Care. 2015;4(6):568–76.

O'Meara E, Rouleau JL, White M, Roy K, Blondeau L, Ducharme A, et al. Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Heart Fail. 2014;7(5):773–81.

Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J. 2005;26(21):2232–7.

Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol. 2012;59(11):998–1005.

Moe GW, Ezekowitz JA, O'Meara E, Lepage S, Howlett JG, Fremes S, et al. The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Focus Update: anemia, biomarkers, and recent therapeutic trial implications. Can J Cardiol. 2015;31(1):3–16.

Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D, et al. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol. 2013;168(4):3439–42.

Gutzwiller FS, Pfeil AM, Comin-Colet J, Ponikowski P, Filippatos G, Mori C, et al. Determinants of quality of life of patients with heart failure and iron deficiency treated with ferric carboxymaltose: FAIR-HF sub-analysis. Int J Cardiol. 2013;168(4):3878–83.

Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiencydagger. Eur Heart J. 2015;36(11):657–68.

Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, et al. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail. 2016;18(7):786–95.

Tefera YG, Abegaz TM, Abebe TB, Mekuria AB. The changing trend of cardiovascular disease and its clinical characteristics in Ethiopia: hospital-based observational study. Vasc Health Risk Manag. 2017;13:143–51.

Abebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM. Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord. 2016;16(1):232.

Mahmood SS, Wang TJ. The epidemiology of congestive heart failure: the Framingham Heart Study perspective. Glob Heart. 2013;8(1):77–82.

Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure. J Am Coll Cardiol. 2003;41(11):1933–9.

WHO, UNICEF, UNU. Iron deficiency anaemia: assessment, prevention and control : a guide for programme managers. Geneva: World Health Organization; 2001.

Adams KF Jr, Patterson JH, Oren RM, Mehra MR, O'Connor CM, Pina IL, et al. Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry. Am Heart J. 2009;157(5):926–32.

Tang YD, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation. 2006;113(20):2454–61.

Paul S, Paul RV. Anemia in heart failure: implications, management, and outcomes. J Cardiovasc Nursing. 2004;19(6 Suppl):S57–66.

Anand IS, Kuskowski MA, Rector TS, Florea VG, Glazer RD, Hester A, et al. Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation. 2005;112(8):1121–7.

Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R, et al. Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med. 2013;368(13):1210–9.

Son Y-J, Kim BH. Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Eur J Cardiovasc Nurs. doi:10.1177/1474515117710154.

Tyminska A, Kaplon-Cieslicka A, Ozieranski K, Peller M, Balsam P, Marchel M, et al. Anemia at Hospital Admission and Its Relation to Outcomes in Patients With Heart Failure (from the Polish Cohort of 2 European Society of Cardiology Heart Failure Registries). Am J Cardiol. 2017;

Hamaguchi S, Tsuchihashi-Makaya M, Kinugawa S, Yokota T, Takeshita A, Yokoshiki H, et al. Anemia is an independent predictor of long-term adverse outcomes in patients hospitalized with heart failure in Japan. A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J. 2009;73(10):1901–8.

Jonsson A, Hallberg AC, Edner M, Lund LH, Dahlstrom U. A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry. Int J Cardiol. 2016;211:124–31.

Mentz RJ, Greene SJ, Ambrosy AP, Vaduganathan M, Subacius HP, Swedberg K, et al. Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial. Circ Heart Fail. 2014;7(3):401–8.

Maggioni AP, Opasich C, Anand I, Barlera S, Carbonieri E, Gonzini L, et al. Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail. 2005;11(2):91–8.

O'Meara E, Clayton T, McEntegart MB, McMurray JJ, Lang CC, Roger SD, et al. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation. 2006;113(7):986–94.

Berry C, Poppe KK, Gamble GD, Earle NJ, Ezekowitz JA, Squire IB, et al. Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis. QJM. 2016;109(6):377–82.

Anand I, McMurray JJ, Whitmore J, Warren M, Pham A, McCamish MA, et al. Anemia and its relationship to clinical outcome in heart failure. Circulation. 2004;110(2):149–54.

Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation. 2006;113(23):2713–23.

Redondo-Bermejo B, Pascual-Figal DA, Hurtado-Martinez JA, Montserrat-Coll J, Penafiel-Verdu P, Pastor-Perez F, et al. Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure. Rev Esp de Cardiol. 2007;60(6):597–606.

Macin SM, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Rios N, et al. Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function. Rev Esp Cardiol. 2004;57(1):45–52.

Ojeda S, Anguita M, Munoz JF, Rodriguez MT, Mesa D, Franco M, et al. Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction? Rev Esp Cardiol. 2003;56(11):1050–6.

Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251–9.

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17.