European Heart Journal Advance Access originally published online on May 22, 2006
European Heart Journal 2006 27(12):1440-1446; doi:10.1093/eurheartj/ehl012
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The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
1 Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, 47-83 Bld de l'Hôpital, 75013, Paris Cedex 13, France
2 Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
3 Clinical Cardiology, National Heart and Lung Institute, Imperial College, London, UK
4 Nottingham Clinical Research Group, Nottingham, UK
5 Cattedra di Cardiologia, Università di Brescia, Trieste, Italy
6 Department of Cardiology, Ospedale di Cattinara, Trieste, Italy
7 Sticares Cardiovascular Research Foundation, Rhoon, The Netherlands
8 F. Hoffmann-La Roche Ltd., Basel, Switzerland
9 Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
10 Department of Cardiology, University of Hull, Kingston-upon-Hull, UK
Received 18 August 2005; revised 4 April 2006; accepted 13 April 2006; online publish-ahead-of-print 22 May 2006.
* Corresponding author. Tel: +33 1 42 16 30 03; fax: +33 1 42 16 30 20. E-mail address: michel.komajda{at}psl.ap-hop-paris.fr
Aims Anaemia is a common comorbidity in chronic heart failure (CHF). The predictors of new onset anaemia (NOA) and its long-term prognostic value, particularly in patients treated with beta-blockers, are not known.
Methods and results In COMET, 3029 patients with CHF in NYHA II–IV and EF <35% were randomized to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Plasma haemoglobin (Hb) concentrations were measured at a central laboratory at randomization, at four monthly intervals for the first year and annually thereafter. According to WHO criteria, anaemia was defined when Hb measured <13 g/dL for men and <12 g/dL for women. We considered anaemia to be severe when Hb <11.5 g/dL for men and <10.5 g/dL for women. The baseline mean Hb was 14.2±1.5 g/dL (n=2996) and 15.9% of patients had anaemia (males, 16.0%; females, 15.2%). At baseline, severe anaemia was found in 3.3% of patients (males, 3.6%; females, 2.0%). During the study, all-cause mortality (RR 1.47) death or hospitalization (RR 1.28), and heart failure hospitalization (RR 1.43, all P<0.0001) were higher in anaemic when compared with non-anaemic patients. In patients without anaemia at baseline, at the end of the study, the cumulative frequency of NOA was 28.1% in males and 27.0% in females. NOA increased over time from 14.2% at year 1 to 27.5% at year 5. Predictors of NOA were: higher age, diuretic dose, creatinine (all P<0.0001), higher serum potassium, lower serum sodium, body mass index, and use of aldosterone antagonists, carvedilol, and digitalis (all P<0.03). Treatment with carvedilol (vs. metoprolol tartrate) was associated with a 24% increased risk to develop NOA (P=0.0047), but not severe anaemia (P=0.18). Patients with a Hb decrease of >3 g/dL (RR 3.37, P<0.0001) or of 2.0–3.0 g/dL (RR 1.47, P=0.011) from baseline had an increased subsequent mortality when compared with patients having Hb increases of 0–1.0 g/dL.
Conclusion In stable ambulatory CHF patients, development of NOA is frequent and can be predicted by a set of clinical variables. Decreases in Hb over time relate to future increased morbidity and mortality.
Key Words: Heart failure • Anaemia • Beta-blockers • Prognosis
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