Abstract 16960: Prognostic Significance of Hypoalbuminemia Among Ambulatory Heart Failure Patients With Reduced and Preserved Ejection Fraction
Background: Hypoalbuminemia is a predictor of adverse outcomes among patients admitted with acute decompensated heart failure. However, the prognostic significance of hypoalbuminemia among ambulatory heart failure (HF) patients is unknown.
Methods: In a national ambulatory cohort of Veterans with HF, we examined the association of hypoalbuminemia with all-cause mortality, HF hospitalization and all-cause hospitalization in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Results: In our cohort of 9,437 ambulatory HF patients, 1,404 (15%) had hypoalbuminemia (serum albumin <3.5gm/dl). Among 2,841 HFpEF patients, 446 (16%) had hypoalbuminemia while among 6,596 HFrEF patients, 958 (15%) had hypoalbuminemia. In both HFpEF and HFrEF groups, compared to patients without hypoalbuminemia, hypoalbuminemic patients had higher prevalence of diabetes, peripheral artery disease, liver disease, cancer, previous HF hospitalization, use of statins, and higher serum BUN levels with lower BMI and hemoglobin (p<0.05). On multivariate Cox proportional hazards models, after adjusting for demographic profile, comorbidities and medication use, hypoalbuminemia was significantly associated with all-cause mortality [HFrEF: HR 1.51, 95% CI: 1.34 - 1.70, p<0.001; HFpEF: HR 1.39, 95% CI: 1.21 - 1.59, p<0.001], HF hospitalization [HFrEF: HR 1.29, 95% CI: 1.12 - 1.49, p=0.001; HFpEF: 1.52, 95% CI: 1.17 - 1.98, p=0.002] and all-cause hospitalization [HFrEF: HR 1.38, 95% CI: 1.26 - 1.51, p<0.001; HFpEF: 1.39, 95% CI: 1.21- 1.59, p<0.001].
Conclusion: Hypoalbuminemia is independently associated with increased mortality and morbidity among ambulatory patients with HFpEF and HFrEF. Hypoalbuminemia may result from hemodilution, malnutrition, chronic inflammation, infection and other mechanisms and is an easily available prognostic biomarker in ambulatory HF patients.
- © 2013 by American Heart Association, Inc.