European Heart Journal: Acute Cardiovascular Care http://acc.sagepub.com/
Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes Katsuya Kajimoto, Naoki Sato, Teruo Takano and on behalf of the investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry European Heart Journal: Acute Cardiovascular Care published online 14 October 2014 DOI: 10.1177/2048872614554199 The online version of this article can be found at: http://acc.sagepub.com/content/early/2014/10/10/2048872614554199
Published by: European Society of Cardiology
ESC Working Group on Acute Cardiac Care
and http://www.sagepublications.com
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>> OnlineFirst Version of Record - Oct 14, 2014 What is This?
Downloaded from acc.sagepub.com at TEMPLE UNIV on November 3, 2014
554199 research-article2014
ACC0010.1177/2048872614554199European Heart Journal: Acute Cardiovascular CareKajimoto et al.
EUROPEAN SOCIETY OF CARDIOLOGY ®
Original scientific paper
Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes
European Heart Journal: Acute Cardiovascular Care 1–9 © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872614554199 acc.sagepub.com
Katsuya Kajimoto1, Naoki Sato2 and Teruo Takano3; on behalf of the investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry
Abstract Background: It remains unclear in which patients hospitalized for acute heart failure syndromes (AHFS) the presence of anemia increases the risk of morbidity or mortality because of the heterogeneity of this patient population. The aim of this study was to evaluate the influence of anemia on the clinical outcome in subgroups of patients hospitalized for AHFS. Methods and results: The study included patients from the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, a nationwide hospital-based prospective observational multicenter cohort of 4842 patients with AHFS admitted to 53 hospitals in Japan. The primary endpoint was all-cause death after admission and the secondary endpoint was a composite of all-cause death and readmission for heart failure (HF). Anemia was detected in 58% of the patients. The all-cause death rate after admission was significantly higher in patients with anemia (31.3%) than in those without anemia (15.5%). To identify the predictors that influence the effect of anemia on all-cause mortality, subgroup analyses were performed. As a result, the presence of anemia on admission was associated with a significantly increased risk of all-cause death in patients aged 40% or if it was qualitatively assessed to be normal or mildly impaired (when LVEF was not measured) at admission, while a reduced EF was defined as LVEF ≤40% or moderate/severe left ventricular systolic dysfunction on qualitative assessment at admission. The primary endpoint was all-cause death after admission while the secondary endpoint was a composite of all-cause death and readmission for HF.
Statistical analysis
The Acute Decompensated Heart Failure Syndromes (ATTEND) registry is a nationwide hospital-based prospective observational multicenter cohort investigation of patients with AHFS admitted to 53 hospitals in Japan (University Hospital Medical Information Network registration number: UMIN 000000736). Patients are enrolled at their first admission and then followed, with data collection being patient-based rather than event-based. The study design, methods and characteristics of the patients have been described previously.13 In brief, the ATTEND registry study was designed to clarify the profile of AHFS patients in Japan, including their demographic and clinical characteristics, current treatment, in-hospital mortality and postdischarge morbidity or mortality. Treatment of AHFS is not specified and is selected by the physician managing each patient. Data accumulated for each registered patient include the demographic profile, past history, baseline characteristics, initial evaluation, medical treatment, procedures, hospital course and disposition. This study was conducted according to the principles of the Declaration of Helsinki. Institutional Review Board Approval was obtained at each participating hospital prior to study commencement and all patients gave written informed consent. The endpoint classification committee (two experienced cardiologists who were not investigators) reviewed all data and obtained confirmation of the cause of death from the primary physician if clarification was required.
Patients and definitions Patients with AHFS who fitted the modified Framingham criteria, which only include variables assessed at admission, were eligible for entry into the registry.14 However, patients less than 20 years old, those with acute coronary syndrome and others considered unsuitable for the study by their attending physicians were excluded. The present study evaluated patients enrolled in the ATTEND registry between April 2007 and December 2011 for whom data on hemoglobin (Hb) at admission, in-hospital data and postdischarge follow-up data were available. Anemia on admission was defined as an Hb
Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes Katsuya Kajimoto, Naoki Sato, Teruo Takano and on behalf of the investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry European Heart Journal: Acute Cardiovascular Care published online 14 October 2014 DOI: 10.1177/2048872614554199 The online version of this article can be found at: http://acc.sagepub.com/content/early/2014/10/10/2048872614554199
Published by: European Society of Cardiology
ESC Working Group on Acute Cardiac Care
and http://www.sagepublications.com
Additional services and information for European Heart Journal: Acute Cardiovascular Care can be found at: Email Alerts: http://acc.sagepub.com/cgi/alerts Subscriptions: http://acc.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Oct 14, 2014 What is This?
Downloaded from acc.sagepub.com at TEMPLE UNIV on November 3, 2014
554199 research-article2014
ACC0010.1177/2048872614554199European Heart Journal: Acute Cardiovascular CareKajimoto et al.
EUROPEAN SOCIETY OF CARDIOLOGY ®
Original scientific paper
Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes
European Heart Journal: Acute Cardiovascular Care 1–9 © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872614554199 acc.sagepub.com
Katsuya Kajimoto1, Naoki Sato2 and Teruo Takano3; on behalf of the investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry
Abstract Background: It remains unclear in which patients hospitalized for acute heart failure syndromes (AHFS) the presence of anemia increases the risk of morbidity or mortality because of the heterogeneity of this patient population. The aim of this study was to evaluate the influence of anemia on the clinical outcome in subgroups of patients hospitalized for AHFS. Methods and results: The study included patients from the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, a nationwide hospital-based prospective observational multicenter cohort of 4842 patients with AHFS admitted to 53 hospitals in Japan. The primary endpoint was all-cause death after admission and the secondary endpoint was a composite of all-cause death and readmission for heart failure (HF). Anemia was detected in 58% of the patients. The all-cause death rate after admission was significantly higher in patients with anemia (31.3%) than in those without anemia (15.5%). To identify the predictors that influence the effect of anemia on all-cause mortality, subgroup analyses were performed. As a result, the presence of anemia on admission was associated with a significantly increased risk of all-cause death in patients aged 40% or if it was qualitatively assessed to be normal or mildly impaired (when LVEF was not measured) at admission, while a reduced EF was defined as LVEF ≤40% or moderate/severe left ventricular systolic dysfunction on qualitative assessment at admission. The primary endpoint was all-cause death after admission while the secondary endpoint was a composite of all-cause death and readmission for HF.
Statistical analysis
The Acute Decompensated Heart Failure Syndromes (ATTEND) registry is a nationwide hospital-based prospective observational multicenter cohort investigation of patients with AHFS admitted to 53 hospitals in Japan (University Hospital Medical Information Network registration number: UMIN 000000736). Patients are enrolled at their first admission and then followed, with data collection being patient-based rather than event-based. The study design, methods and characteristics of the patients have been described previously.13 In brief, the ATTEND registry study was designed to clarify the profile of AHFS patients in Japan, including their demographic and clinical characteristics, current treatment, in-hospital mortality and postdischarge morbidity or mortality. Treatment of AHFS is not specified and is selected by the physician managing each patient. Data accumulated for each registered patient include the demographic profile, past history, baseline characteristics, initial evaluation, medical treatment, procedures, hospital course and disposition. This study was conducted according to the principles of the Declaration of Helsinki. Institutional Review Board Approval was obtained at each participating hospital prior to study commencement and all patients gave written informed consent. The endpoint classification committee (two experienced cardiologists who were not investigators) reviewed all data and obtained confirmation of the cause of death from the primary physician if clarification was required.
Patients and definitions Patients with AHFS who fitted the modified Framingham criteria, which only include variables assessed at admission, were eligible for entry into the registry.14 However, patients less than 20 years old, those with acute coronary syndrome and others considered unsuitable for the study by their attending physicians were excluded. The present study evaluated patients enrolled in the ATTEND registry between April 2007 and December 2011 for whom data on hemoglobin (Hb) at admission, in-hospital data and postdischarge follow-up data were available. Anemia on admission was defined as an Hb
