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Listen "Verification of haemoglobin level to prevent worsening of prognosis in heart failure with preserved ejection fraction patients from the PURSUIT-HFpEF registry"
Episode Synopsis
Verification of haemoglobin level to prevent worsening of prognosis in heart failure with preserved ejection fraction patients from the PURSUIT-HFpEF registry
https://doi.org/10.1002/ehf2.14927
Abstract
Aim
Anaemia has been reported as poor predictor
in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the impact of changes in haemoglobin (Hb) from discharge
to 1 year after discharge on the prognosis using a lower cut-off value of Hb than the World Health Organization (WHO) criteria.
Methods and results
First, 547 heart failure with preserved ejection fraction cases were divided into two groups, Hb < 11.0 g/dL (n
= 218) and Hb ≥ 11.0 g/dL (n = 329), according to Hb
at discharge, and further were divided according to Hb 1 year after discharge into Hb < 11.0 g/dL (G1, n = 113), Hb ≥ 11.0 g/dL (G2, n = 105), Hb < 11.0 g/dL (G3, n = 66), and Hb ≥ 11.0 g/dL (G4, n = 263), respectively. Major adverse cardiovascular events (MACE) was defined as composite of all-cause death and heart failure readmission after a visit 1 year after discharge. The cut-off value of Hb was analysed by the receiver operating characteristics curve
that predicts Major adverse cardiovascular events. We examined the incidence rate of Major adverse cardiovascular events between G4 and other subgroups and verified predictors of improving or worsening anaemia and covarying factors with change in Hb.
In multivariate Cox proportional hazard model, MACE was significantly higher in G3 with worsening anaemia from Hb ≥ 11.0 g/dL to <11.0 g/dL than G4 with persistently Hb ≥ 11 g/dL (adjusted hazard ratio (HR):
3.14 [95% confidence interval (CI), 1.76–5.60], P < 0.001). Major adverse cardiovascular events was not significantly different between G2 with improving anaemia from Hb
< 11.0 g/dL to ≥ 11.0 g/dL andG4 (adjusted HR: 1.37 [95%
CI, 0.68–2.75], P = 0.38). In multivariate logistic regression analysis, independent predictors of improving anaemia were male [odds ratio (OR): 0.45], chronic
obstructive pulmonary disease (OR: 10.3), prior heart failure hospitalization (OR: 0.38), and estimated glomerular filtration rate (OR: 1.04). Independent predictors of worsening anaemia were age (OR:
1.07), body mass index (BMI) (OR: 0.86), clinical frailty scale score (OR: 1.29), Hb at discharge (OR: 0.63), and use of angiotensin-converting-enzyme inhibitor or angiotensin II receptor blocker (OR: 2.76). In
multivariate linear regression analysis, covarying
factors with change in Hb were BMI (β = −0.098), serum albumin (β = 0.411), and total cholesterol (β = 0.179).
Conclusions
Change in haemoglobin after discharge using a
lower cut-off value than World Health Organization criteria has prognostic impact in patients with heart failure with preserved ejection fraction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this
website.
https://doi.org/10.1002/ehf2.14927
Abstract
Aim
Anaemia has been reported as poor predictor
in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the impact of changes in haemoglobin (Hb) from discharge
to 1 year after discharge on the prognosis using a lower cut-off value of Hb than the World Health Organization (WHO) criteria.
Methods and results
First, 547 heart failure with preserved ejection fraction cases were divided into two groups, Hb < 11.0 g/dL (n
= 218) and Hb ≥ 11.0 g/dL (n = 329), according to Hb
at discharge, and further were divided according to Hb 1 year after discharge into Hb < 11.0 g/dL (G1, n = 113), Hb ≥ 11.0 g/dL (G2, n = 105), Hb < 11.0 g/dL (G3, n = 66), and Hb ≥ 11.0 g/dL (G4, n = 263), respectively. Major adverse cardiovascular events (MACE) was defined as composite of all-cause death and heart failure readmission after a visit 1 year after discharge. The cut-off value of Hb was analysed by the receiver operating characteristics curve
that predicts Major adverse cardiovascular events. We examined the incidence rate of Major adverse cardiovascular events between G4 and other subgroups and verified predictors of improving or worsening anaemia and covarying factors with change in Hb.
In multivariate Cox proportional hazard model, MACE was significantly higher in G3 with worsening anaemia from Hb ≥ 11.0 g/dL to <11.0 g/dL than G4 with persistently Hb ≥ 11 g/dL (adjusted hazard ratio (HR):
3.14 [95% confidence interval (CI), 1.76–5.60], P < 0.001). Major adverse cardiovascular events was not significantly different between G2 with improving anaemia from Hb
< 11.0 g/dL to ≥ 11.0 g/dL andG4 (adjusted HR: 1.37 [95%
CI, 0.68–2.75], P = 0.38). In multivariate logistic regression analysis, independent predictors of improving anaemia were male [odds ratio (OR): 0.45], chronic
obstructive pulmonary disease (OR: 10.3), prior heart failure hospitalization (OR: 0.38), and estimated glomerular filtration rate (OR: 1.04). Independent predictors of worsening anaemia were age (OR:
1.07), body mass index (BMI) (OR: 0.86), clinical frailty scale score (OR: 1.29), Hb at discharge (OR: 0.63), and use of angiotensin-converting-enzyme inhibitor or angiotensin II receptor blocker (OR: 2.76). In
multivariate linear regression analysis, covarying
factors with change in Hb were BMI (β = −0.098), serum albumin (β = 0.411), and total cholesterol (β = 0.179).
Conclusions
Change in haemoglobin after discharge using a
lower cut-off value than World Health Organization criteria has prognostic impact in patients with heart failure with preserved ejection fraction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this
website.
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