European Heart Journal Advance Access published online on May 22, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl012
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1 Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, 47-83 Bld de l'Hôpital, 75013, Paris Cedex 13, France
* To whom correspondence should be addressed. 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.
Received August 18, 2005
Revised April 4, 2006
Accepted April 13, 2006
Clinical research
The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
Michel Komajda 1 *,
Stefan D. Anker 2,
Andrew Charlesworth 3,
Darlington Okonko 4,
Marco Metra 5,
Andrea Di Lenarda 6,
Willem Remme 7,
Christine Moullet 8,
Karl Swedberg 9,
John G.F. Cleland 10,
Philip A. Poole-Wilson 4,
and
for the COMET Investigators
2 Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany; Clinical Cardiology, National Heart and Lung Institute, Imperial College, London, UK
3 Nottingham Clinical Research Group, Nottingham, UK
4 Clinical Cardiology, National Heart and Lung Institute, Imperial College, London, 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
Michel Komajda, E-mail: michel.komajda{at}psl.ap-hop-paris.fr
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