Abstract 2190: Anemia and Survival in Chronic Heart Failure: a meta-analysis
Background. Anemia is frequently observed in patients with Chronic Heart Failure (CHF), although a wide range prevalences of anemia has been published. Several studies found an increased mortality risk of anemia in CHF, but the precise risk estimates remain unclear. The objective of this meta-analysis is to assess the effect of anemia on mortality in CHF.
Methods. A systematic literature search in MEDLINE (through January 2007) was performed. In addition, a manual search was performed using review articles and reference lists of papers. Longitudinal studies reporting the association between anemia and mortality in CHF were included. The mortality risk associated with anemia was estimated using random-effect meta-analysis.
Results. Out of a total of 1086 initial studies we included 27 in this meta-analysis. Anemia was defined as: WHO, ICD-9 coding criteria, Hemoglobin (Hb) < 12 g/dL, < 12.5 g/dL, Hematocrit < 36% and < 37%, respectively. In total 93,660 patients were included. The prevalence of anemia in CHF was 35.5%. After a minimal follow-up of 6 months, 42.7% of anemic patients died compared to 31.8% of nonanemic patients. Crude mortality risk of anemia was 1.93 (95% CI 1.72–2.16, p < 0.001). Reported adjusted Hazard Ratios showed an increased adjusted risk for anemia of 1.47 (95% CI 1.31–1.65, p < 0.001). Subgroup analysis showed no significant difference between mortality risk of anemia in diastolic or systolic CHF.
Conclusion. Anemia is associated with a substantial increased risk of mortality in both systolic and diastolic CHF. Therefore it should be considered as a useful prognosticator in CHF and therapeutic strategies aimed to increase Hb levels in CHF should be investigated.