Abstract 2501: Anaemia is associated with poor outcome in patients with heart failure and preserved ejection fraction (HF PEF). Findings from the Irbesartan in Heart Failure with Preserved Systolic Function Trial (I-PRESERVE).
Background: Anaemia is frequent in patients with HF and reduced left ventricular ejection fraction and is an independent predictor of mortality and rehospitalisation. The prevalence of anaemia and its effect on prognosis have not been defined in a large cohort of well characterized patients with HF PEF. We therefore addressed these questions in the I PRESERVE trial.
Methods: I PRESERVE randomized 4128 patients with an EF > 45% to receive Irbesartan/placebo. Anaemia was defined by a plasma haemoglobin level < 13g/dl at baseline. 957 patients with Hb values (24%) were anaemic by this criterion. Important baseline characteristics differences were observed between anaemic and non anaemic patients: age > 75y (45% vs 31%), female gender (75% vs 56%), mean BUN (24 vs 20 mg/dl, e GFR < 60 ml/mn (42% vs 27%), HF hospitalization < 6 months (49% vs 42%), BMI < 25 kg/m2 (21% vs 15%), history of diabetes (34% vs 25%), all p < 0.0001 and presence of pulmonary congestion on X ray (43% vs 39%, p = 0.04). By contrast, no differences were observed in baseline EF, heart rate, systolic blood pressure or NYHA class. The primary endpoint (all cause mortality and cardiovascular hospitalization) occurred in 18% vs 11% at one year (HR = 1.71, 95% ; CI = 1.43–2.06) and heart failure death or hospitalization in 13% vs 6% (HR = 2.06 ; CI = 1.64 –2.60), both p < 0.001. In a multivariate model, anaemia remained an independent predictor for both primary and HF endpoints (HR = 1.29 ; CI = 1.06 –1.58 for primary endpoint ; HR = 1.44 , CI = 1.12–1.85 for HF endpoint).
Conclusion: The prevalence of anaemia and the clinical characteristics of anaemic patients with HF PEF are similar to those observed in low EF patients. HF PEF patients with anaemia have a significantly worse outcome than those without anaemia and this increased risk is independent of other factors associated with worse outcome.