Diferencias en la supervivencia entre los pacientes con IC que aumentan o no sus cifras de hemoglobina (anemia)Read less
![Improvement of Anemia is Associated with Improved Survival in Elderly Heart Failure Patients . J. Ortiz 1 , M. Mendez 2 , S. Nieto 1 , N. Muñoz 2 , P. Renieblas 2 , C. Sanchez 2 , A. Perez 2 , L. Audibert 2 1 Geriatric Service and 2 Internal Medicine Department, Hospital Gregorio Marañón. Spain. RESULTS ABSTRACT Improvement of anemia is associated with improved survival in elderly patients with heart failure. M. * Mendez, S. ** Nieto, N. * Muñoz, P. * Renieblas, C. * Sanchez, A. Perez *, L. Audibert *, J. Ortiz ** * Internal Medicine and ** Service Geriatric Hospital Gregorio Marañón, Madrid. Introduction . Anemia is prevalent in elderly patients with Heart failure (HF) and is associated with increased morbidity and mortality. However, the effect of correction of anemia on survival has not been well studied. Objective . The present study examines, in patients with HF and mild anemia, the effect of correction of anemia on survival. Patients and Methods . Of 306 consecutive elderly patients included in a HF disease management program, 152 were found to have anemia. Of these, 125 were studied. All patients received HF management according to guidelines. Treatment of anemia included iron or erythropoietin and iron in most of the patients. At the end of follow-up, patients were divided into anemia improved (AI) if Hb improved during follow-up (N=89) and anemia not improved (ANI) if Hb decline or remained equal (N=36). Primary outcome measure was survival after admission to the HF program. Kaplan-Meier curves and log-rank test, and Cox regression model were used to determine if recovery of anemia is an independent predictor. Results . At baseline, there were no differences between groups in Hb (10.9 v s 11.2 g/dL; AI vs ANI), age (79 yr), functional status and NYHA class, Charlson comorbidity index, renal function, left ventricular ejection fraction and proportion with severe pulmonary hypertension. Over a mean of 9.5 ±6.5 months, mean Hb levels increased to 12.5 ± 1.3 in the AI group and decline to 10.6 ±1.5 g/d in the group ANI group, 12/89 (14%) patients in the AI group and 12/36 (33%) in group ANI group died. Patients in the AI group were less likely of dying than the NI group during the observation period (log rank test: p = 0.018). In Cox regression analysis, after adjusting for baseline and other prognostic variables, the AI group was independently associated with increased survival time. Conclusions : In elderly HF patients with mild anemia, improved anemia leads to increased survival. Efforts should be made to diagnose and treat even mild degrees of anemia in elderly HF patients. ,[object Object],[object Object],[object Object],OBJECTIVE To assess the effect of correction of anemia on survival in elderly patients with HF and mild anemia . C 125 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],P<0.001 P=0.22 Change in Hemoglobin MORTALITY Baseline & Outcome Variables ANI N=36 AI N=89 p value Age – yr 78,8±8,9 78,6±8,9 0.896 Female – nº (%) 18 (50) 52 (58) 0.508 Total independence in Physical ADL 18 (50) 47 (53) 0.931 Charlson Index 3.86 ± 2.18 3.2 ± 1.7 0.100 Comorbidities – nº (%): ,[object Object],27 (75) 83(93) 0.011 ,[object Object],16 (44) 32 (36) 0.496 ,[object Object],16 (44) 22 (25) 0.051 ,[object Object],3 (8,3) 15 (17) 0.343 ,[object Object],8 (22) 9 (10) 0.133 ,[object Object],23 (64) 58 (65) 0.943 ,[object Object],11,2 ± 1,3 10,9± 1,2 0.228 Etiology of HF – nº (%): ,[object Object],13 (36) 36 (40) 0.804 ,[object Object],16 (44) 42 (47) 0.935 ,[object Object],16 (44) 51 (57) 0.268 Clinical profile of HF – nº (%): ,[object Object],16 (45) 38 (41) 0.983 ,[object Object],26 (72) 64 (72) 0.853 ,[object Object],14 (39) 47 (53) 0.225 # Glomerular filtration rate <60 ml/min estimated by the MDRD equation Multivariate Proportional Hazard Model of Risk Factors of Death* HR 95% CI P Value AI Group 0.39 0.17 – 0.91 0.028 Charlson Index ( Increase of 1) 1.22 1.01 – 1.48 0.039 Gender (male) 1.20 0.49 – 2.89 0.693 LV Ejection fraction (<50%) 1.95 0.78 – 4.85 0.152 * Include variables significant in bivariate analysis ANI AI p Deaths - n (%) 12 (33) 12 (13) 0.021 Rate of deaths per 100 person-years 46 17 0.023 Kaplan-Meier Plot of Survival Free of Death by Groups. Log rank test p=0.018](https://image.slidesharecdn.com/posteramericano2009-100408120535-phpapp01/85/anemia-e-insuficiencia-cardiaca-manuel-mndez-bailn-hospital-infanta-leonor-madrid-1-320.jpg)
