Abstract 3174: Prevalence and Predictors of Hospital-Acquired Anemia in Patients Hospitalized with Acute Myocardial Infarction
Anemia is common in patients (pts) hospitalized with acute myocardial infarction (AMI), and associated with increased mortality. While some AMI pts have anemia at baseline, the prevalence and correlates of acute, hospital-acquired anemia (HAA) in this pt population is unknown. TRIUMPHANT is an ongoing 26-center study of AMI treatment and outcomes. Pts who were anemic at baseline (n=439), had CABG (n=159) or died (n=7) in-hospital, and those without complete admission and discharge hemoglobin (Hgb) (n=3) were excluded, leaving 1246 pts for the analysis. Of these, 452 and 312 pts respectively agreed to have scheduled in-home Hgb assessments at 1 and 6 months post-discharge. Beutler and Waalen definition (Hgb ≤13.7 g/dL for younger and ≤13.2 for older white men, ≤12.9 for younger and ≤12.7 for older black men, ≤12.2 for white and ≤11.5 for black women) was used to classify pts as anemic on admission, discharge and follow up. Pts not anemic on admission, but anemic on discharge were defined as those with HAA. Hierarchical Poisson regression was used to determine independent predictors of HAA. At discharge, 584 pts (47%) developed HAA. Of these, 145 (25%) developed severe or moderate HAA (Hgb ≤9.0 and 9.1–11 respectively). Mean Hgb decline in-hospital among pts with HAA was 2.5 g/dL. Independent predictors of HAA were increasing age (RR 1.10, 95% CI 1.07–1.14 per 10 yrs.), chronic kidney disease (1.33 (1.12–1.59)), use of glycoprotein IIb/IIIa inhibitors (1.21 (1.08 –1.36)), cardiogenic shock (1.66, (1.44 –1.91)), and bleeding in-hospital (TIMI minimal, minor and major vs. none: 1.45 (1.10 –1.89), 2.07 (1.60 –2.68), 2.20 (1.67–2.91)). While cardiogenic shock and bleeding were strong independent predictors of HAA, the overwhelming majority (97% and 85% respectively) of HAA pts did not experience these complications. Among pts with HAA and complete follow-up data, 25 and 23% had persistent anemia at 1 and 6 months post-discharge. Nearly half of pts with normal admission Hgb develop HAA during AMI hospitalization, but most do not have a documented bleeding event. A substantial proportion of pts with HAA have persistent anemia during follow up. Further investigation into the causes and prognostic implications of HAA is warranted.