Abstract 18466: Anemia is Associated with an Adverse Outcome in Patients with Atrial Fibrillation: Insights Form the Re-ly Trial
Background: Anemia may predispose to cardiovascular events. While patients with atrial fibrillation (AF) may be particularly prone to anemia, the impact of anemia on outcome in patients with AF is unclear.
Methods: We retrospectively analyzed the RE-LY trial that randomized 18,113 patients with AF to receive dabigatran or warfarin for a median follow-up of 2 years.The association between anemia (Hb <13.0 g/dL in men and <12.0 g/dL in women) and the incidence of cardiovascular and bleeding events was assessed with multivariable Cox regression analysis.
Results: Anemia was present in 12% of the population at baseline and the presence of anemia was associated with an increased incidence of all cause mortality or myocardial infarction (adjusted hazard ratio (adj. HR) 1.50, 95% confidence interval (CI) 1.32-1.71). Anemia was also associated with an increased incidence of the primary RE-LY endpoints of stroke or systemic embolism (adj. HR 1.41 95% CI (1.12-1.78)) and major bleeding (adj. HR 2.14, 95% CI 1.87-2.46). The association between anemia and outcome did not differ according to major cardiovascular comorbidities, treatment allocation or prior use of warfarin. After 6 months, anemia had resolved in 35% of anemic patients, while anemia had developed in 10% of patients without prior anemia. Resolution of anemia was associated with a more favorable outcome than sustained anemia (adj HR. 0.71, 95%CI 0.97-0.52), or new onset anemia (adj HR. 0.68, 95%CI 0.50-0.93)
Conclusions: Anemia is associated with an increased risk of cardiovascular events and bleeding complications in patients with AF. Accordingly, resolution of anemia is associated with a more favourable outcome than sustained anemia.
- © 2012 by American Heart Association, Inc.