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Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure

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Abstract

The optimum method of managing anemia during the acute phase of acute heart failure (AHF) remains to be elucidated. The data from 1109 AHF patients were enrolled in present study. The hemoglobin (Hb) levels were evaluated in all patients at admission (day 1) and 3 days after admission (day 3), and in survival discharge patients (n = 998) before discharge (pre-discharge). The serum hemoglobin levels were significantly lower on day 3 (11.2 (9.6–12.9) g/dl) than on day 1 (12.4 (10.4–14.2) g/dl) and at pre-discharge (11.6 (10.1–13.2) g/dl). A multivariate Cox regression model showed that mild anemia (11.0 ≤ Hb ≤ 12.9 g/dl, n = 316) and severe anemia (Hb ≤ 10.9 g/dl, n = 517) on day 3 were independent predictors of HF event (hazard ratio (HR) 1.542, 95% confidence interval (CI)1.070–2.221, HR 2.026, 95% CI 1.439–2.853), and severe anemia on day 3 were independent predictors of 365-day mortality (HR 2.247, 95% CI 1.376–3.670). The prognosis, including all-cause death and HF events, in patients with non-anemia on day 1 was significantly poorer in severe new-anemia patients on day 3 (n = 44) than in mild new-anemia patients on day 3 (n = 153) and non-anemia patients on day 3 (n = 252). In patients with anemia on day 1, the prognosis was significantly poorer in patients with severe anemia on day 3 (n = 190) than in those with non-anemia or mild anemia on day 3 (n = 482). The hemoglobin level after the initial treatment might be easily influenced by clinical decongestion. Successfully treated decongestion can help maintain the hemoglobin levels. It, therefore, leads to a prognostic benefit in patients with AHF. These findings might underscore the importance of hemoglobin management of the acute phase of AHF.

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Acknowledgements

We are grateful to the staff of the ICU and the medical records office at Nippon Medical School Chiba Hokusoh Hospital for collecting the medical data.

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Authors and Affiliations

  1. Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan

    Akihiro Shirakabe, Noritake Hata, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Suguru Nishigoori & Saori Uchiyama

  2. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

    Kuniya Asai & Wataru Shimizu

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  1. Akihiro Shirakabe
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  2. Noritake Hata
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  3. Nobuaki Kobayashi
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  10. Wataru Shimizu
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Correspondence to Akihiro Shirakabe.

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This research received no grants from any funding agency in the public, commercial or not-for-profit sectors.

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The authors declare no conflicts of interest in association with the present study.

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Shirakabe, A., Hata, N., Kobayashi, N. et al. Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure. Heart Vessels 33, 264–278 (2018). https://doi.org/10.1007/s00380-017-1057-5

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