Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: Results from the MAGGIC individual patient data meta-analysis

Colin Berry, Katrina K. Poppe, G. D. Gamble, Nikki Earle, Justin A. Ezekowitz, Iain Squire, John J V McMurray, F. A. McAlister, Michel Komajda, Karl Swedberg, Aldo Pietro Maggioni, Ali Ahmed, Gillian A. Whalley, Robert N. Doughty, Luigi Tarantini, Christopher B. Granger, Lars Køber, B. Massie, Stuart J. Pocock, J. SomaratneB. Andersson, A. Bayes-Genis, Martin R. Cowie, R. Cubbon, Jose Ramón Gonzalez-Juanatey, Marco Gorini, I. Gotsman, L. Grigorian-Shamagian, Marco Guazzi, M. Kearney, Andrea Di Lenarda, Mattie J. Lenzen, Donata Lucci, Stella M. MacIn, B. Madsen, Manuel Martinez-Selles, Fabrizio Oliva, M. W. Rich, M. Richards, Michele Senni, G. Taffet, Christophe Tribouilloy, Richard W. Troughton, H. Tsutsui, Cono Ariti, J. Dobson, C. Hall, J. Lainchbury, K. Hogg, J. Norrie, K. Stevenson, M. Brett, Marc A. Pfeffer, Peter Held, Eric L. Michelson, Bertil Olofsson, Jan Ostergren, Salim Yusuf, Christian Torp-Pedersen, Wilma Scholte Op Reimer, E. Boersma, Pascal Vantrimpont, Ferenc Follath, John G F Cleland, Donna Zwas, D. Planer, T. Azaz-Livshits, D. Admon, Chaim Lotan, A. Keren, A. Varela-Roman, P. Mazón-Ramos, P. Rigeiro-Veloso, M. A. Bandin-Dieguez, Jonathan Myers, R. Arena, Paul W. Armstrong, Bibiana Cujec, Ian Paterson, D. A. Wood, A. J S Coats, S. G. Thompson, V. Suresh, Philip Alexander Poole-Wilson, G. C. Sutton, J. A G Robles, L. Prieto, M. D. Muñoa, E. Frades, O. Díaz-Castro, Jesús Almendral, Pompilio Faggiano, D. Bertoli, Maurizio Porcu, Cristina Opasich, Luigi Tavazzi, V. Kirk, M. Bay, J. Parner, K. Krogsgaard, T. M. Herzog, S. Boesgaard, Christian Hassager, Olav Wendelboe Nielsen, J. Aldershvile, Henrik Nielsen, L. Kober, E. R. Perna, J. P. Cimbaro Canella, P. Alvarenga, R. Pantich, N. Ríos, E. F. Farias, J. R. Badaracco, J. F. Hansen, K. H. Stokholm, J. Brons, D. Husum, L. S. Mortensen, R. Vazquez, T. Puig, C. Fernandez-Palomeque, A. Bardají, D. A. Pascual-Figal, J. Ordoñez-Llanos, M. Valdes, Albert Gabarrus, R. Pavon, L. Pastor, M. Fiol, V. Nieto, Carlos Macaya, Juan Cinca, I. Cygankiewitz, A. Bayes de Luna, J. Newton, H. M. Blackledge, S. P. Wright, R. Kerzner, B. F. Gage, K. E. Freedland, B. C. Huynh, A. Rovner, R. M. Carney, T. A. Teasdale, A. J. Bleyer, N. J. Kutka, R. J. Luchi, Dan Rusinaru, H. Mahjoub, V. Soulière, F. Lévy, M. Peltier, M. Tsuchihashi, A. Takeshita, Philip MacCarthy, J. Nolan, A. J. Lee, R. J. Prescott, Ajay M. Shah, W. P. Brooksby, Keith A A Fox, P. Basante, R. Trillo, Javier Garcia-Seara, Jose Luis Martinez-Sande, F. Gude

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Background: Anaemia is common among patients with heart failure (HF) and is an important prognostic marker. Aim: We sought to determine the prognostic importance of anaemia in a large multinational pooled dataset of prospectively enrolled HF patients, with the specific aim to determine the prognostic role of anaemia in HF with preserved and reduced ejection fraction (HF-PEF and HF-REF, respectively). Design: Individual person data meta-analysis. Methods: Patients with haemoglobin (Hb) data fromthe MAGGIC dataset were used. Anaemia was defined as Hb < 120 g/l in women and <130 g/l inmen. HF-PEF was defined as EF ≥ 50%; HF-REF was EF < 50%. Cox proportional hazardmodelling, with adjustment for clinically relevant variables, was undertaken to investigate factors associated with 3-year all-causemortality. Results: Thirteen thousand two hundred and ninety-five patients with HF from 19 studies (9887 with HF-REF and 3408 with HF-PEF). The prevalence of anaemia was similar among those with HF-REF and HF-PEF (42.8 and 41.6% respectively). Compared with patients with normal Hb values, those with anaemia were older, were more likely to have diabetes, ischaemic aetiology, New York Heart Association class IV symptoms, lower estimated glomerular filtration rate and were more likely to be taking diuretic and less likely to be taking a beta-blocker. Patients with anaemia had higher all-cause mortality (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.25-1.51), independent of EF group: aHR 1.67 (1.39-1.99) in HFPEF and aHR 2.49 (2.13-2.90) in HF-REF. Conclusions: Anaemia is an adverse prognostic factor in HF irrespective of EF. The prognostic importance of anaemia was greatest in patients with HF-REF.

Original languageEnglish
Pages (from-to)377-382
Number of pages6
JournalQJM - Monthly Journal of the Association of Physicians
Issue number6
Publication statusPublished - 2016

ASJC Scopus subject areas

  • Medicine(all)


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