ANEMIA IN HOSPITALIZED PATIENTS WITH SEVERE HEART FAILURE
Received for publication: 11th of October, 2010
Revised: 2nd of November, 2010
SUMMARY: (Hide the summary)
We proposed the investigation of anaemia as comorbidity in patients with severe heart failure. We studied a total of 214 patients hospitalized with heart failure stage III and IV NYHA and EF <40% of which 66 were documented with anaemia, in which we investigated demographic data, clinical, laboratory, diagnosis of associated chronic diseases. Kidney involvement was documented in 40% of cases, 30% had severe anaemia, a result of both losses and lack of intake. Anaemia often accompanies impaired systolic function, iron deficiency and chronic kidney disease are common, therapeutic evaluation and correction of anaemia has important prognostic implications.
heart failure, anaemia, ejection fraction.
Recent literature draws attention to a haematology pathology associated with heart failure - anaemia - common comorbidity, it can compete in worsenin symptoms and may also be responsible for the rehospitalisation of the patient.
The prevalence of anaemia in patients with heart failure is important to be known, the quality of life, the exercise capacity can be improved by appropriate therapy and its correction. We proposed the evaluation of anaemia in relation to the classification in degrees of severity of heart failure symptoms, signs, echocardiographic examination, aetiology and medication.
MATERIAL AND METHOD
We studied patients with heart failure hospitalized within a year in the cardiology department. Of the 368 patients, we selected 214 who had clinical events included in that heart failure NYHA III and IV and ejection fraction <40%.
The causes of heart failure have been classified - hypertension, coronary disease, valvular heart disease. We evaluated the clinical presentation, presence of stasis rales, hepatomegaly, stasis and cardiomegaly at radiological examination, ECG abnormalities. We evaluated the renal function, the thyroid and gastrointestinal function in order to diagnose the presence of comorbidities.
We took into account haemoglobin values below 12g/dL in men and 11.5g/dl in women and serum iron values.
Of the 214 patients with heart failure NYHA III and IV and ejection fraction below 40%, 66 had a haemoglobin value that confirmed anaemia as the aetiology of heart failure: 24 had coronary artery disease, 20 valvular disease, 22 were hypertensive; 3 patients associated hyperthyroid and 21 chronic obstructive pulmonary disease. Diabetes mellitus was associated in 34 patients. (Figure.1)
Renal failure was recorded as comorbidity in 29 patients. Iron deficiency was documented in 32 patients, in 10 a source of bleeding was confirmed - gastrointestinal in 7, genital in 2, kidney in 1. (Figure.2, Figure.3)
Anaemia was present in a significant percentage of patients with advanced clinical forms of heart failure – 66 of 214, an association commonly noted in the literature (1).
In one third of patients - iron deficiency anaemia type was documented in 22, of which only 10 had a documented cause for bleeding.
Chronic renal failure is frequently a cause of anaemia (2) frequent another does not seem to have etiological features in heart failure that accompanies anaemia.
Fig. 1. Comorbidities
Fig. 2. Iron deficiency
Fig. 3. Source of bleeding
Resuming patient history, in 11 patients the iron deficiency component is likely through food intake, suggesting a more complex deficiency, including lack of care and is a possible contributory cause of aggravation and readmission of patients.
Mental component of anxiety and / or depression was diagnosed in 9 patients by psychiatric test, which also suggests an aggravating comorbidity for both anaemia and heart failure.
In the absence of a proper anaemia correction, the prognosis is questionable both in young people with impaired diastolic function (3) but also in those with impaired systolic function (4) (5).
Our study suggests that anaemia is a common comorbidity associated with heart failure, regardless of cause. Iron deficiency due to loss or lack of food intake is common in relation to a digestive disease and a psychiatric one. Among the chronic diseases, chronic renal failure seems to be the most common.
Diagnosis of anaemia, of cause, clinical form, comorbidities and their correction, improves their prognosis and reduces hospital readmissions for heart failure.
- Thon T, Haase M, Rosamond V, Howard VD – American Heart Association Statistics Committee Circulation 2006, 113, 85-151
- McChellan WM, Flanders WD – Anaemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals J.Am. Soc. Nephrol. 2002, 13, 1928-36
- Brucks S, Little WC, Chao T – Relation of anaemia to diastolic heart failure and the effect on outcome Am.J.Cardiol. 2004, 93, 1055-57
- Felker GM, Shaw LK, Stough WG – Anaemia in patients with heart failure and reserved systolic function Am.Heart J. 2006, 151, 457-462
- Kosibarad M, Smith GL, Radford MJ – The prognostic compliance of anaemia in patients with congestive heart failure admitted to community hospitals – J.Am.Soc.Nephrol. 2002, 13, 1928-36.