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...

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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
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Abstract	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.
AbstractList	Abstract Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined 433 patients enrolled in the ESCAPE trial. Results Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1 g/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 (mm Hg) (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 (10 days vs. 6 days, p = < 0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2 g/dL: 10% versus 3%, p = 0.010; 3 g/dL: 5% versus 0%, p = 0.005). After adjustments, a drop of hemoglobin with at least 1 g/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 1 g/dL: 1.88, p = 0.043; Hb Drop 2 g/dL: 3.6 p = 0.025). Conclusion 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. 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. The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown.INTRODUCTIONThe 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.METHODSWe 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).RESULTSOf 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.CONCLUSIONIn-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.
Author	Myerburg, Robert J. Gilchrist, Ian C. Al-Damluji, Mohammed S. Damluji, Abdulla A. Marzouka, George R. Garcia, Grettel Moscucci, Mauro Macon, Conrad Fox, Arieh Cohen, Mauricio G.
Author_xml	– sequence: 1 givenname: Abdulla A. surname: Damluji fullname: Damluji, Abdulla A. organization: Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States – sequence: 2 givenname: Conrad surname: Macon fullname: Macon, Conrad organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 3 givenname: Arieh surname: Fox fullname: Fox, Arieh organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 4 givenname: Grettel surname: Garcia fullname: Garcia, Grettel organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 5 givenname: Mohammed S. surname: Al-Damluji fullname: Al-Damluji, Mohammed S. organization: Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States – sequence: 6 givenname: George R. surname: Marzouka fullname: Marzouka, George R. organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 7 givenname: Robert J. surname: Myerburg fullname: Myerburg, Robert J. organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 8 givenname: Ian C. surname: Gilchrist fullname: Gilchrist, Ian C. organization: Penn State Heart & Vascular Institute, Hershey, PA, United States – sequence: 9 givenname: Mauricio G. surname: Cohen fullname: Cohen, Mauricio G. organization: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States – sequence: 10 givenname: Mauro surname: Moscucci fullname: Moscucci, Mauro email: mmoscucc@lifebridgehealth.org organization: Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States
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Snippet	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... Abstract Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined... The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown.INTRODUCTIONThe effect of acute changes of...
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SubjectTerms	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
Title	The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial
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