Clinical impact of red blood cell transfusion on adverse clinical events in acute heart failure patients with anemia
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.
References (28)
- et al.
The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations
J. Am. Coll. Cardiol.
(2000) - et al.
Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure
J. Am. Coll. Cardiol.
(2002) - et al.
Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure
Am. J. Cardiol.
(2003) - et al.
Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE)
J. Am. Coll. Cardiol.
(2003) - et al.
Anemia of inflammation
Blood
(2019) - et al.
Iron deficiency in heart failure: an overview
JACC Heart Fail.
(2019) - 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) - et al.
Ferric carboxymaltose in patients with heart failure and iron deficiency
N. Engl. J. Med.
(2009) - 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) - et al.
Treatment of anemia with darbepoetin alfa in systolic heart failure
N. Engl. J. Med.
(2013)
Rehospitalizations among patients in the Medicare fee-for-service program
N. Engl. J. Med.
Hospital cost of care, quality of care, and readmission rates: penny wise and pound foolish?
Arch. Intern. Med.
Survival after the onset of congestive heart failure in Framingham heart study subjects
Circulation
Anemia and iron deficiency in heart failure: current concepts and emerging therapies
Circulation
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2021, International Journal of CardiologyClinical impact of red blood cell transfusion on adverse clinical events in acute heart failure patients with anemia
2021, International Journal of Cardiology