Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure

Abstract

Background:

Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure.

Aims:

We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure.

Methods:

This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews.

Results:

The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% (p = 0.001) and 55.1% vs. 34% (p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19–29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22–4.60) in patients with heart failure.

Conclusion:

It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.

Keywords

Anemia heart failure prevalence hospital readmission emergency department

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References

Ross

Chen

Lin

. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2010; 3: 97–103.

Chun

Wijeysundera

. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail 2012; 5: 414–421.

Lee

Lim

Cho

. Epidemiology of heart failure in Korea: Present and future. Korean Circ J 2016; 46: 658–664.

Feltner

Jones

Cené

. Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Ann Intern Med 2014; 160: 774–784.

Horwich

Fonarow

Hamilton

. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002; 39: 1780–1786.

Blecker

Ladapo

Doran

. Emergency department visits for heart failure and subsequent hospitalization or observation unit admission. Am Heart J 2014; 168: 901–908 e1.

Shafazand

Patel

Ekman

. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care. BMC Res Notes 2012; 5: 132.

Braunwald

. Heart failure. JACC Heart Fail 2013; 1: 1–20.

Berry

Poppe

Gamble

. Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: Results from the MAGGIC individual patient data meta-analysis. QJM 2016; 109: 377–382.

10.

Venkateswaran

Freeman

Chatterjee

. Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization therapy. J Interv Card Electrophysiol 2015; 44: 297–304.

11.

Groenveld

Januzzi

Damman

. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 2008; 52: 818–827.

12.

Verheijden Klompstra

Jaarsma

Moons

. Anaemia and iron deficiency in cardiac patients: What do nurses and allied professionals know? Eur J Cardiovasc Nurs 2012; 11(Suppl. 1): S90–S95.

13.

Rangel

Goncalves

de Sousa

. Iron deficiency status irrespective of anemia: A predictor of unfavorable outcome in chronic heart failure patients. Cardiology 2014; 128: 320–326.

14.

Yancy

Jessup

Bozkurt

. 2013 ACCF/AHA guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128: 1810–1852.

15.

O’Meara

Clayton

McEntegart

. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation 2006; 113: 986–994.

16.

Tang

Yeo

. Epidemiology of anemia in heart failure. Heart Fail Clin 2010; 6: 271–278.

17.

Adams

Jr Patterson

Oren

. Prospective assessment of the occurrence of anemia in patients with heart failure: Results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry. Am Heart J 2009; 157: 926–932.

18.

Tanner

Moschovitis

Kuster

. The prevalence of anemia in chronic heart failure. Int J Cardiol 2002; 86: 115–121.

19.

Tang

Katz

. Anemia in chronic heart failure: Prevalence, etiology, clinical correlates, and treatment options. Circulation 2006; 113: 2454–2461.

20.

Young

Abraham

Albert

. Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol 2008; 101: 223–230.

21.

Anand

Kuskowski

Rector

. Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation 2005; 112: 1121–1127.

22.

Anand

McMurray

Whitmore

. Anemia and its relationship to clinical outcome in heart failure. Circulation 2004; 110: 149–154.

23.

McMahon

Mason

Skinner

. Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure. Nephrol Dial Transpl 2000; 15: 1425–1430.

24.

Le Jemtel

Arain

. Mediators of anemia in chronic heart failure. Heart Fail Clin 2010; 6: 289–293.

25.

WHO, UNICEF, UNU. Iron deficiency anaemia: Assessment, prevention and control, a guide for programme managers. Geneva: World Health Organization, 2001.

26.

Elabbassi

Fraser

Williams

. Prevalence and clinical implications of anemia in congestive heart failure patients followed at a specialized heart function clinic. Congest Heart Fail 2006; 12: 258–264.

27.

Paul

. Anemia in heart failure: Implications, management, and outcomes. J Cardiovasc Nurs 2004; 19: S57–S66.

28.

Shah

Agarwal

. Anemia associated with chronic heart failure: Current concepts. Clin Interv Aging 2013; 8: 111–122.

29.

Kraai

Luttik

Johansson

. Health-related quality of life and anemia in hospitalized patients with heart failure. Int J Cardiol 2012; 161: 151–155.

30.

Kyriakou

Kiff

. Prognosis of the comorbid heart failure and anemia: A systematic review and meta-analysis. Clin Trials Regul Sci Cardiol 2016; 16: 12–21.

31.

Colín-Ramírez

Castillo-Martínez

Orea-Tejeda

. Body composition and echocardiographic abnormalities associated to anemia and volume overload in heart failure patients. Clin Nutr 2006; 25: 746–757.

32.

Cooper

Anker

Comin-Colet

. Relation of longitudinal changes in quality of life assessments to changes in functional capacity in patients with heart failure with and without anemia. Am J Cardiol 2016; 117: 1482–1487.

33.

Doehner

von Haehling

Anker

. Anaemia predicts health related quality of life in heart failure patients. Int J Cardiol 2013; 162: 67–68.

34.

Anand

. Pathophysiology of anemia in heart failure. Heart Fail Clin 2010; 6: 279–288.

35.

Komajda

. Prevalence of anemia in patients with chronic heart failure and their clinical characteristics. J Card Fail 2004; 10: S1-S4.

36.

Mozaffarian

Benjamin

. Heart disease and stroke statistics-2016 update: A report from the American Heart Association. Circulation 2016; 133: e1–e323.

37.

Tsuchihashi

Tsutsui

Kodama

. Medical and socioenvironmental predictors of hospital readmission in patients with congestive heart failure. Am Heart J 2001; 142: 20A-26A.

38.

Aizawa

Imai

Fushimi

. Factors associated with 30-day readmission of patients with heart failure from a Japanese administrative database. BMC Cardiovasc Disord 2015; 15: 134.

39.

Philbin

Dec

Jenkins

. Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol 2001; 87: 1367–1371.

40.

Fida

Pina

. Trends in heart failure hospitalizations. Curr Heart Fail Rep 2012; 9: 346–353.

41.

Silverberg

Wexler

Blum

. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000; 35: 1737–1744.

42.

Moe

. Heart failure with multiple comorbidities. Curr Opin Cardiol 2016; 31: 209–216.

43.

Olandoski

de Lima

da Silva

. Interaction of anemia and decrease in renal function on survival of patients with heart failure. Int J Cardiol 2012; 154: 338–340.

44.

Zaya

Phan

Schwarz

. Predictors of re-hospitalization in patients with chronic heart failure. World J Cardiol 2012; 4: 23–30.

45.

Schonwetter

Clark

Leedy

. Predicting emergency room visits and hospitalizations among hospice patients with cardiac disease. J Palliat Med 2008; 11: 1142–1150.