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(Circulation. 2006;113:986-994.)
© 2006 American Heart Association, Inc.

Heart Failure

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

Eileen O’Meara, MD, FRCPC; Tim Clayton, BSc, MSc; Margaret B. McEntegart, MB, MRCP; John J.V. McMurray, MD; Chim C. Lang, MD; Simon D. Roger, MD, FRACP; James B. Young, MD; Scott D. Solomon, MD; Christopher B. Granger, MD; Jan Östergren, MD, PhD; Bertil Olofsson, PhD; Eric L. Michelson, MD; Stuart Pocock, BA, MSc, PhD; Salim Yusuf, DPhil, FRCPC; Karl Swedberg, MD, PhD; Marc A. Pfeffer, MD, PhD, for the CHARM Committees and Investigators

From the Western Infirmary, Glasgow, UK (E.O., M.B.M., J.J.V.M.); Montreal Heart Institute, Montreal, Quebec, Canada (E.O.); London School of Hygiene and Tropical Medicine, London, UK (T.C., S.P.); Ninewells Hospital & Medical School, Dundee, UK (C.C.L.); Gosford Hospital, Gosford, New South Wales, Australia (S.D.R.); Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); Brigham & Women’s Hospital, Boston, Mass (S.D.S, M.A.P.); Duke University Medical Center, Durham, NC (C.B.G.); Karolinska University Hospital Solna, Stockholm, Sweden (J.O.); AstraZeneca, R&D, Mölndal, Sweden (B.O.); AstraZeneca LP, Wilmington, Del (E.L.M.); HGM-McMaster Clinic, Hamilton, Ontario, Canada (S.Y.); and Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.).

Correspondence to Professor John J.V. McMurray, Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, United Kingdom. E-mail j.mcmurray{at}bio.gla.ac.uk

Received August 11, 2005; revision received December 14, 2005; accepted December 22, 2005.

Background— We wished to determine the prevalence of, potential mechanistic associations of, and clinical outcomes related to anemia in patients with heart failure and a broad spectrum of left ventricular ejection fraction (LVEF).

Methods and Results— In multivariable analyses, we examined the associations between hemoglobin and baseline characteristics, laboratory variables, and outcomes in 2653 patients randomized in the CHARM Program in the United States and Canada. Anemia was equally common in patients with preserved (27%) and reduced (25%) LVEF but was more common in black and older patients. Anemia was associated with ethnicity, diabetes, low body mass index, higher systolic and lower diastolic blood pressure, and recent heart failure hospitalization. More than 50% of anemic patients had a glomerular filtration rate <60 mL · min^–1 · 1.73 m^–2 compared with <30% of nonanemic patients. Despite an inverse relationship between hemoglobin and LVEF, anemia was associated with an increased risk of death and hospitalization, a relationship observed in patients with both reduced and preserved LVEF. There were 133 versus 69 deaths and 527 versus 352 hospitalizations per 1000 patient-years of follow-up in anemic versus nonanemic patients (both P<0.001). The effect of candesartan in reducing outcomes was independent of hemoglobin.

Conclusions— Anemia was common in heart failure, regardless of LVEF. Lower hemoglobin was associated with higher LVEF yet was an independent predictor of adverse mortality and morbidity outcomes. In heart failure, the causes of anemia and the associations between anemia and outcomes are probably multiple and complex.

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