Impact of Cardiorenal Anemia Syndrome on Physical Function and Clinical Outcomes in Older Patients with Acute Heart...

Cardiorenal anemia syndrome (CRAS), defined by the coexistence of heart failure (HF), chronic kidney disease (CKD), and anemia, is common in older patients with HF and is associated with adverse outcomes. Physical function is an important determinant of prognosis and quality of life; however, data regarding the relationship between CRAS, physical function, and prognosis in older patients hospitalized with acute HF remain limited.

This study was a subanalysis of the Japan Prospective Observational Study of Heart Failure in Older Patients (J-Proof HF), a prospective multicenter registry. Patients were categorized into four groups: HF only, anemia only, CKD only, and CRAS. The primary outcome was 1-year all-cause mortality. Physical function was assessed using the Short Physical Performance Battery (SPPB).

Among 8,700 patients (median age, 83 years; 48.8% female), the prevalence of CRAS was 56.7%. During 1-year follow-up, 1,621 patients (18.7%) died. In multivariable analyses, CRAS was independently associated with 1-year all-cause mortality (hazard ratio, 1.26; 95% confidence interval, 1.12-1.42) and lower SPPB scores. Furthermore, the combination of CRAS and impaired physical function identified patients at particularly high risk of mortality, whereas patients with CRAS but preserved physical function did not exhibit a significantly increased mortality risk.

In older patients hospitalized with acute HF, CRAS was highly prevalent and independently associated with lower physical function and increased 1-year mortality. Assessment of physical function in addition to CRAS may provide incremental prognostic information and help refine risk stratification in older patients with HF.