The Effect Of Anemia On 2-years Prognosis Of Patients With Different Types Of Heart Failure

Objective:Heart failure is an important public health problem in the earth.Despite the emergence of new treatments and preventive measures,the morbidity and mortality of patients with heart failure are still very high.Anemia is considered to be one of the important factors affecting the poor prognosis of heart failure.At present,most studies have focused on the effects of anemia on patients with reduced ejection fraction and heart failure(HFrEF;LVEF<40%).There is evidence that anemia may have different effects on different types of heart failure,but this trend has not been consistently reported.With the redefinition of heart failure typing in the diagnosis and treatment guidelines of heart failure in Europe,America,China and other countries,anemia includes the preservation of ejection fraction of heart failure(HFpEF;LVEF≥ 50%)and the newly named median value of ejection fraction.The effects of various types of heart failure patients including HF(HFmrEF;LVEF 40%-49%)need to be clarified.The purpose of this study was to observe the effects of anemia and the severity of anemia on the demographic characteristics,clinical characteristics,and 2-year prognosis of three different types of heart failure,HFrEF,HFmrEF,and HFpEF.Methods:Using a retrospective multi-center cohort study and analysis method,Patients who were collected from March 1st,2014 to February 28th,2016,and were treated in Tianjin tertiary hospitals(including Tianjin Medical University General Hospital,Tianjin Chest Hospital,Tianjin Medical University)Second Affiliated Hospital,Tianjin People’s Hospital,Tianjin Wuqing District People’s Hospital,Affiliated Hospital of Tianjin Institute of Traditional Chinese Medicine,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Fifth Central Hospital of Tianjin,Xiqing Hospital of Tianjin,Tanggu Hospital,etc.)The basic clinical data of patients diagnosed with heart failure in hospital.A total of 1,521 patients with heart failure who had complete clinical data and completed the follow-up of 2-year endpoint events were included.According to the 2018 Chinese Heart Failure Guidelines,according to the different left ventricular ejection fraction(LVEF),it is divided into three groups:HFrEF,HFmrEF and HFpEF.There are ejection fraction retention(HFpEF),median ejection fraction(HFmEF),and ejection fraction reduction HFrEF)three types of heart failure,each group is divided into two subgroups according to whether anemia is combined(anemia standard:hemoglobin male<120 g/L,female<110 g/L),re-admitted to heart failure or all-cause death As the end event,describe the demographic characteristics of heart failure and different types of heart failure with anemia,compare the clinical characteristics of heart failure and different types of heart failure with anemia,and explore the 2-year prognosis of anemia and the severity of anemia to patients with different types of heart failure influences.Results:A total of 2284 cases were collected in this study.A total of 1521 patients were selected for follow-up.Among them,447(29.4%)were anemia patients and 1047 were non-anemic patients.Among the anemia patients,there were158(30.27%)in HFmEF、153(24.3%)in HFrEF、136(37.0%)in the HFpEF group.A total of 411 cases of heart failure were re-hospitalized and 441 cases of all-cause deaths in 2 years follow-up.There were 705 composite endpoint events.In this study,the included inpatients with heart failure were analyzed according to non-type and type of anemia,based on the definition and diagnosis of anemia and heart failure in China,which showed:1.The prevalence and epidemiological demographic characteristics This study found that there was no gender difference in the prevalence of anemia between men and women(259 males with anemia,29.26%prevalence,188 females with anemia,29.56%prevalence,P=0.901).Regardless of the type,the age of anemia patients is older than that of non-anemic patients,the smoking rate is low,the length of hospitalization is long,and the cost of hospitalization is high(all P<0.05).2.The overall hemoglobin level of hospitalized patients with heart failure is mainly distributed in 130-139g/1,120-129 g/1,110-119 g/1,of which men are mainly 130-139g/1,140-149 g/1,120-129 g/1,120-129 g/1 for women,110-119 g/l,130-139 g/1.3.Compared with non-anemic patients(all P<0.05),patients with heart failure and anemia in this study population have the following clinical characteristics:more likely to have coronary heart disease,renal insufficiency,hypoproteinemia,hypertension,etc.Disease,and the prevalence of arrhythmia,atrial fibrillation,dilated cardiomyopathy is low,the ratio of high grade NYHA is more,higher low density lipoprotein cholesterol,creatinine,urea nitrogen value,lower albumin value,etc.,drugs In terms of applications,ACEI,aldosterone receptor blockers,and angiotensin receptor inhibitors(ACEI)have a low application rate,and calcium antagonists(CCB)have a high application rate.Heart failure differed by type(all P>0.05).There was no difference in the prevalence of coronary heart disease and atrial fibrillation in the HFrEF group.There was no difference in the use of hypertension and aldosterone antagonists in the HFmEF group,and no difference in the prevalence of hypertension,arrhythmia,and atrial fibrillation in the HFPEF group.4.In the case of no classification of patients with heart failure,univariate COX analysis,age,hospitalization days,renal insufficiency,hypoproteinemia,dilated cardiomyopathy,anemia are heart failure rehospitalization,all-cause death and Risk factors for poor prognosis of the composite end point,after multivariate adjustment of age,length of hospitalization,renal insufficiency,hypoproteinemia,and dilated cardiomyopathy,showed that anemia is still all-cause death[1.439(1.177-1.759)P<0.001]Prognostic factors for increased risk.Among the different types of heart failure,anemia occurred in three types of end events compared with non-anemic patients.Among patients with HFmEF and HFrEF,heart failure was re-hospitalized(35.44%vs 24.74%,34.64%vs 23.85%),and all-cause death(37.34%vs 23.44%,37.25%vs.23.43%)and composite endpoints(55.70%vs.41.93%,55.56%vs.40.59%)were higher in the anemia group(P<0.05),while in the HFpEF anemia group only for all-cause mortality[1.674(1.206-2.326)P=0.016]has an impact.5.According to the diagnosis and definition of anemia in China,after stratifying the level of anemia(mild anemia Hb<120g/1,moderate anemia Hb≤90g/1,severe anemia Hb≤60g/l)Compared with the normal group with hemoglobin≥120g/1,mild and moderate anemia are risk factors for the prognosis of heart failure rehospitalization,all-cause death,and composite endpoint.Severe anemia is associated with heart failure rehospitalization[2.633(0.979-7.079)P=0.055]has no effect and is a prognostic factor for all-cause death[4.274(1.899-9.619)P<0.001]and composite endpoint[2.964(1.403-6.260)P=0.004]In HFrEF,mild and moderate anemia are risk factors for re-hospitalization of heart failure,all-cause death,and poor prognosis of composite endpoint(P<0.05).There was no effect on the poor prognosis of the composite endpoint.In HFmEF,mild anemia had no effect on the rehospitalization of heart failure,all-cause death,and poor prognosis of the composite endpoint(P>0.05).Moderate anemia was the rehospitalization of heart failure.1.310-3.645)P=0.003],all-cause death[2.241(1.342-3.739)P=0.002]and composite end point[2.038(1.358-3.060)P=0.001]risk factors for poor prognosis,severe anemia is all-cause death[6.201(1.520-25.299)P=0.011]Adverse prognostic factors.In HFpEF,moderate and severe anemia are the adverse prognostic factors of all-cause death(all P<0.5).Mild anemia(P≥0.05)is associated with heart failure Rehospitalization,all-cause death,and poor prognosis of the composite endpoint had no effect.Conclusion:This study indicated:1.Anemia was related to the ejection fraction of HF,and the prevalence of anemia had an increasing trend with the increase of ejection fraction.2.In terms of prevalence and epidemiological demographic features,this study found that there was no gender difference in prevalence between men and women.Regardless of the type,anemia patients were older than non-anemic patients,had a low smoking rate,long hospital stays,and high hospitalization costs.3.Patients with heart failure and anemia in the study population had the following clinical characteristics:they were more likely to have comorbidities such as coronary heart disease,renal insufficiency,hypoproteinemia,and hypertension,while arrhythmia,atrial fibrillation,dilated cardiomyopathy The prevalence was low,and the causes and complications of the three types of heart failure were different.4.Regardless of the type,anemia was still a prognostic factor for the increased risk of all-cause death.5.After stratification of anemia(mild anemia Hb<120g/1,moderate anemia Hb<90g/1,severe anemia Hb<60g/1),among patients with different types of heart failure,mild and moderate And severe anemia had different effects on the prognosis of heart failure rehospitalization,all-cause death,and composite end point.