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Anaemia and coronary artery disease severity in patients with heart failure

G Michael Felker1, Wendy Gattis Stough, Linda K Shaw

  • 1Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA. michael.felker@duke.edu

European Journal of Heart Failure
|August 23, 2005
PubMed

Insights

Anemia in heart failure (HF) patients is linked to mortality. However, this study found anemia’s mortality risk was highest in patients without coronary artery disease (CAD), not those with severe CAD.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Anemia is prevalent in heart failure (HF) patients, correlating with increased mortality.
  • A proposed mechanism linking anemia and mortality in HF is the exacerbation of myocardial ischemia.

Purpose of the Study:

  • To investigate if coronary artery disease (CAD) severity amplifies the negative impact of anemia on HF outcomes.
  • To test the hypothesis that greater CAD severity exacerbates anemia's adverse effects in HF patients.

Main Methods:

  • Analysis of 4951 symptomatic HF patients (NYHA class ≥ II) who underwent coronary angiography (1995-2003).
  • Exclusion of patients with primary valvular or congenital heart disease.
  • Cox proportional hazards modeling to assess the relationship between CAD severity (number of diseased vessels) and hemoglobin levels.

Main Results:

  • An interaction between hemoglobin levels and CAD severity was observed (p = 0.003).
  • The mortality risk associated with anemia was highest in patients without CAD.
  • Mortality risk decreased progressively with increasing CAD severity.

Conclusions:

  • Contrary to the hypothesis, anemia poses the greatest mortality risk in HF patients without significant CAD.
  • These findings suggest that mechanisms other than myocardial ischemia exacerbation are involved in anemia's impact on HF outcomes.
Abstract

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