Elsevier

International Journal of Cardiology

Volume 324, 1 February 2021, Pages 102-107
International Journal of Cardiology

Clinical impact of red blood cell transfusion on adverse clinical events in acute heart failure patients with anemia

https://doi.org/10.1016/j.ijcard.2020.09.028Get rights and content

Highlights

  • Patients with AHF present with various comorbidities, including anemia

  • It has been unclear whether RBC transfusion influences clinical outcomes

  • We studied AHF readmission and all-cause mortality after RBC transfusion

  • RBC transfusion was not associated with either outcome

Abstract

Background

Anemia has been recognized as an important comorbidity in patients with acute heart failure (AHF) and is associated with adverse clinical events. However, the clinical impact of red blood cell (RBC) transfusion in such patients is unclear.

Method

This study was a retrospective single-center registry including AHF patients admitted to Kyorin University Hospital between 2007 and 2014. Anemia was defined as a hemoglobin level < 130 g/L in males or < 120 g/L in females. Those with major bleeding with a fall in hemoglobin concentration of >20 g/L were excluded. AHF readmission at 3 months and in-hospital and 2-year all-cause mortality were evaluated.

Results

Of 501 AHF patients, 38 were excluded owing to major bleeding; finally, 463 (age, 77 ± 11 years; males, 58%) were evaluated. RBC transfusion during hospitalization was performed in 112 patients (24%). Hemoglobin level on admission was 105 ± 16 g/L (transfusion, 89 ± 17 g/L; no transfusion, 110 ± 12 g/L; p < 0.001). AHF readmission at 3 months and in-hospital and 2-year all-cause mortality were observed in 46 (10%), 16 (3%), and 121 (26%) patients, respectively. Univariate Cox regression analysis demonstrated that RBC transfusion was not associated with AHF readmission at 3 months (hazard ratio: 0.80; 95% confidence interval: 0.39–1.66) The association did not differ at any hemoglobin concentration or left ventricular ejection fraction value. Multivariate Cox regression analysis revealed similar results. Furthermore, RBC transfusion was not correlated with in-hospital and 2-year all-cause mortality.

Conclusions

RBC transfusion was not associated with AHF readmission or all-cause mortality.

Introduction

Anemia has been recognized as an important comorbidity in patients with congestive heart failure; its prevalence varies from 30% to 55% [[1], [2], [3]]. Anemia is associated with adverse clinical events such as mortality and readmission [[3], [4], [5]]. Ferro therapy for heart failure patients with iron-deficiency anemia was not noted to reduce long-term mortality, but it improved the 6-min walk test and quality-of-life assessments [6]. A previous study demonstrated that ferro therapy might be associated with a reduction in the risk of hospitalization for worsening heart failure [7]. Darbepoetin alfa, an erythropoiesis-stimulating agent, was expected to improve prognosis; however, the therapy did not improve clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia [8]. Rather, such agents may be associated with serious adverse effects. It is unclear whether anemia itself affects the clinical outcomes or the cause of anemia does. Indeed, the clinical implication of transfusion in acute heart failure (AHF) patients with anemia has not been investigated. AHF readmission has recently attracted attention because repeat hospitalization is related to the increased costs of health care and early readmission contributes to the subsequent worse outcomes [9,10]. Therefore, assessment of AHF readmission is important as well as mortality. The present study aimed to elucidate the clinical impact of transfusion of red blood cell (RBC) on AHF readmission and mortality in patients with AHF and anemia.

Section snippets

Study population

The study was a single-center, retrospective registry study. AHF patients with anemia who admitted to Kyorin University Hospital between 2007 and 2014 were included. Based on Framingham criteria, a diagnosis of AHF was defined as rapid–onset heart failure, new or worsening signs, and symptoms of heart failure requiring urgent therapy and hospitalization [11]. According to the definition provided by the World Health Organization, anemia was defined as a hemoglobin level < 130 g/L in males or

Patient characteristics

The present study included 463 patients (age, 77 ± 11 years; males, 58%). Of them, 112 (24%) received RBC transfusion. The patient characteristics are shown in Table 1. Hemoglobin level on admission was 105 ± 16 g/L (transfusion, 89 ± 17 g/L; no transfusion, 110 ± 12 g/L; p < 0.001). In comparison, the value at discharge was 110 ± 15 g/L (transfusion, 104 ± 13 g/L; no transfusion, 112 ± 15 g/L; p < 0.001).

The causes of anemia in patients with RBC transfusion

Of 112 patients who received RBC transfusion, renal anemia was observed in 29 patients;

Discussion

To the best of our knowledge, the present study is the first to state that RBC transfusion is associated with neither reduction of AHF readmission nor all-cause mortality. It is noteworthy that the treatment for anemia is not correlated with such outcomes while the anemia itself is associated with adverse events [[3], [4], [5]]. Etiologies of anemia vary; it may occur along with worsened general condition in some cases. The conditions that induce anemia, not the reduction in the hemoglobin

Conclusions

RBC transfusion was not associated with short-term AHF readmission or with short- and long-term all-cause mortality. The present study might include AHF patients with various etiologies of anemia. Therefore, further studies classified according to specific causes of the morbidity are necessary to confirm the significance of RBC transfusion.

Author statement

Satoshi Higuchi designed the study, analyzed and interpreted data, and drafted manuscript. Noritaka Hata analyzed and interpreted data, revised the manuscript critically for important intellectual content. Shigeki Shibata, Kazukuri Hirabuki, Tomoya Suda, Kazuna Honda, Hiroshi Hasegawa, and Takeaki Matsuda contributed to acquisition of data, and revised the manuscript critically for important intellectual content. Final approval of the manuscript submitted was done by all the authors.

Funding source

None.

Declaration of Competing Interest

Dr. Satoshi Higuchi has received lecture fees from Medtronic Japan Co., Ltd., Daiichi Sankyo Co., Ltd., and Ono Pharmaceutical Co., Ltd. All other authors have no conflict of interest to disclose.

Acknowledgments

None.

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