Dataset Information

Association of anaemia and all-cause mortality in patients with ischaemic heart failure varies by renal function status.

ABSTRACT:

Aims

The aims of the current study were to evaluate the association between anaemia and all-cause mortality according to chronic kidney disease (CKD) status and to explore at what level of haemoglobin concentration would the all-cause mortality risk increase prominently among CKD and non-CKD patients, respectively.

Methods and results

This is a prospective cohort study, and 1559 patients with ischaemic heart failure (IHF) were included (mean age of 63.5 ± 11.0 years, 85.8% men) from December 2015 to June 2019. Patients were divided into the CKD (n = 481) and non-CKD (n = 1078) groups based on the estimated glomerular filtration rate of 60 mL/min/1.73 m² . In the CKD group, the incidence rate of all-cause mortality in anaemic and non-anaemic patients was 15.4 per 100 person-years and 10.8 per 100 person-years, respectively, with an incidence rate ratio of 1.42 (95% confidence interval: 1.00-2.02; P-value = 0.05). In the non-CKD group, the incidence rate of all-cause mortality in anaemic and non-anaemic patients was 9.8 per 100 person-years and 5.5 per 100 person-years, respectively, with an incidence rate ratio of 1.78 (95% confidence interval: 1.20-2.59; P-value = 0.005). After a median follow-up of 2.1 years, the cumulative incidence rate of all-cause mortality in anaemic and non-anaemic patients was 41.5% and 44.1% (P-value = 0.05) in the CKD group, and 30.9% and 18.1% (P-value < 0.0001) in the non-CKD group. In the CKD group, cumulative incidence rate of all-cause mortality increased prominently when haemoglobin concentration was below 100 g/L, which was not observed in the non-CKD group.

Conclusions

Results of the current study indicated that among IHF patients, the association between anaemia and all-cause mortality differed by the renal function status. These findings underline the importance to assess mortality risk and manage anaemia among IHF patients according to the renal function status.

SUBMITTER: Cai A

PROVIDER: S-EPMC8120417 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

Association of anaemia and all-cause mortality in patients with ischaemic heart failure varies by renal function status.

Cai Anping A Wu Zejia Z Xu Lan L Xia Shuang S He Xuyu X Zhang Ying Y Chen Jiyan J Zhou Yingling Y Li Liwen L

ESC heart failure 20210410 3

<h4>Aims</h4>The aims of the current study were to evaluate the association between anaemia and all-cause mortality according to chronic kidney disease (CKD) status and to explore at what level of haemoglobin concentration would the all-cause mortality risk increase prominently among CKD and non-CKD patients, respectively.<h4>Methods and results</h4>This is a prospective cohort study, and 1559 patients with ischaemic heart failure (IHF) were included (mean age of 63.5 ± 11.0 years, 85.8% men) fr ...[more]

PMID: 33838020

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Project description:BackgroundRemote patient management (RPM) in heart failure (HF) patients has been investigated in several prospective randomized trials. The Telemedical Interventional Management in Heart Failure II (TIM-HF2)-trial showed reduced all-cause mortality and hospitalizations in heart failure (HF) patients using remote patient management (RPM) vs. usual care (UC). We report the trial's results for prespecified eGFR-subgroups.MethodsTIM-HF2 was a prospective, randomized, controlled, parallel-group, unmasked (with randomization concealment), multicenter trial. A total of 1,538 patients with stable HF were enrolled in Germany from 2013 to 2017 and randomized to RPM (+UC) or UC. Using CKD-EPI-formula at baseline, prespecified subgroups were defined. In RPM, patients transmitted their vital parameters daily. The telemedical center reviewed and co-operated with the patient's General Practitioner (GP) and cardiologist. In UC, patients were treated by their GPs or cardiologist applying the current guidelines for HF management and treatment. The primary endpoint was the percentage of days lost due to unplanned cardiovascular hospitalizations or death, secondary outcomes included hospitalizations, all-cause, and cardiovascular mortality.ResultsOur sub analysis showed no difference between RPM and UC in both eGFR-subgroups for the primary endpoint (<60 ml/min/1.73 m2: 40.9% vs. 43.6%, p = 0.1, ≥60 ml/min/1.73 m2 26.5 vs. 29.3%, p = 0.36). In patients with eGFR < 60 ml/min/1.73 m2, 1-year-survival was higher in RPM than UC (89.4 vs. 84.6%, p = 0.02) with an incident rate ratio (IRR) 0.67 (p = 0.03). In the recurrent event analysis, HF hospitalizations and all-cause death were lower in RPM than UC in both eGFR-subgroups (<60 ml/min/1.73 m2: IRR 0.70, p = 0.02; ≥60 ml/min/1.73 m2: IRR 0.64, p = 0.04). In a cox regression analysis, age, NT-pro BNP, eGFR, and BMI were associated with all-cause mortality.ConclusionRPM may reduce all-cause mortality and HF hospitalizations in patients with HF and eGFR < 60 ml/min/1.73 m2. HF hospitalizations and all-cause death were lower in RPM in both eGFR-subgroups in the recurrent event analysis. Further studies are needed to investigate and confirm this finding.

Project description:OBJECTIVES:Anaemia is a risk of worsening heart failure. However, anaemia sometimes remains undetected because the superficial cardiac function does not precisely reflect the adverse impact of anaemia. Plasma B-type natriuretic peptide (BNP) could be helpful in these cases. However, the direct anaemic effects on BNP remain unknown. Herein, we compared the direct effect of anaemia on BNP and left ventricular ejection fraction (LVEF) using an advanced statistical procedure. DESIGN:A retrospective study. SETTING:Secondary care (cardiology), single-centre study. PARTICIPANTS:The study consisted of 3756 inpatients, including 684 without ischaemic heart disease (IHD) and 3072 with IHD. PRIMARY AND SECONDARY OUTCOME MEASURES:Relationship between plasma BNP levels and LVEF values. RESULTS:A path model was constructed to simultaneously examine the adverse impact of anaemia on LVEF and plasma BNP, allowing for renal function. The path model revealed that LVEF increased in response to low haemoglobin (Hb), and the phenomenon was prominent in non-IHD (standardised regression coefficients (St.β): -0.264, p<0.001) rather than in IHD (St.β: 0.015, p=0.531). However, the response of BNP was commonly observed in both groups (non-IHD St.β: -0.238, IHD St.β: -0.398, p<0.001, respectively). Additionally, this study showed a direct link between low estimated glomerular filtration rate and high BNP independently of LVEF. Incrementally, Bayesian structural equation modelling in covariance structure analysis clearly supported this result. The scatter plots and simple regression analysis revealed that an adequate blood supply was approximately Hb 110 g/L and over in the non-IHD patients, whereas blood was not supplied in sufficient quantities even by Hb 130 g/L in patients with IHD. CONCLUSION:The current study demonstrated that anaemia was a substantial risk for worsening cardiac overload as estimated by plasma BNP. The anaemic response of LVEF likely changed depending on underlying cardiac disorders (IHD or not). However, the response of BNP was robustly observed.

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Dataset Information

Association of anaemia and all-cause mortality in patients with ischaemic heart failure varies by renal function status.

Aims

Methods and results

Conclusions

Publications

Association of anaemia and all-cause mortality in patients with ischaemic heart failure varies by renal function status.

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