The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial

The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. We examined 433 patients enrolled in the ESCAPE trial. Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1g...

Full description

Saved in:
Bibliographic Details
Published in:International journal of cardiology Vol. 222; pp. 531 - 537
Main Authors: Damluji, Abdulla A., Macon, Conrad, Fox, Arieh, Garcia, Grettel, Al-Damluji, Mohammed S., Marzouka, George R., Myerburg, Robert J., Gilchrist, Ian C., Cohen, Mauricio G., Moscucci, Mauro
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 01.11.2016
Subjects:
Acute Disease
Aged
Anemia
Biomarkers - blood
Cardiac Catheterization - mortality
Cardiac Catheterization - trends
Cardiovascular
Female
Heart failure
Heart Failure - blood
Heart Failure - diagnosis
Heart Failure - mortality
Hemoglobin
Hemoglobins - metabolism
Hospitalization
Hospitalization - trends
Humans
Length of Stay - trends
Male
Middle Aged
Mortality
Mortality - trends
Prognosis
Heart failure
Hemoglobin
Hospitalization
Prognosis
Anemia
Mortality
ISSN:0167-5273, 1874-1754, 1874-1754
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. We examined 433 patients enrolled in the ESCAPE trial. Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p=0.011), had lower systolic BP (mmHg) (99 vs. 106, p=0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p=0.025), higher BUN (mg/dL) (37 vs. 26, p<0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p<0.001) and higher hospital length of stay (10days vs. 6days, p=<0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2g/dL: 10% versus 3%, p=0.010; 3g/dL: 5% versus 0%, p=0.005). After adjustments, a drop of hemoglobin with at least 1g/dL was associated with increased mortality risk (Adjusted HR 2.38, p=0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p=0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1g/dL: 1.88, p=0.043; Hb Drop 2g/dL: 3.6 p=0.025). In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ObjectType-Undefined-3
ISSN:0167-5273
1874-1754
1874-1754
DOI:10.1016/j.ijcard.2016.07.264