ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 8
Aug.  2021
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Please cite this article as: Spazzafumo L, Olivieri F, Sabbatinelli J, Galeazzi R, Recchioni R, Marcheselli F, Tamburrini P, Antonicelli R. Prognostic relevance of normocytic anemia in elderly patients affected by cardiovascular disease. J Geriatr Cardiol 2021; 18(8): 654−662. DOI: 10.11909/j.issn.1671-5411.2021.08.008
Citation: Please cite this article as: Spazzafumo L, Olivieri F, Sabbatinelli J, Galeazzi R, Recchioni R, Marcheselli F, Tamburrini P, Antonicelli R. Prognostic relevance of normocytic anemia in elderly patients affected by cardiovascular disease. J Geriatr Cardiol 2021; 18(8): 654−662. DOI: 10.11909/j.issn.1671-5411.2021.08.008

Prognostic relevance of normocytic anemia in elderly patients affected by cardiovascular disease

doi: 10.11909/j.issn.1671-5411.2021.08.008
*The authors contributed equally to this manuscript
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  •  BACKGROUND Anemia associated with cardiovascular diseases (CVD) is a common condition in older persons. Prevalence and prognostic role of anemia were extensively studied in patients with myocardial infarction (MI) or congestive heart failure (CHF) whereas limited data were available on patients with atrial fibrillation (AF). This study was conducted to assess the clinical prevalence and prognostic relevance of anemia in elderly patients affected by AF and other CVDs. METHODS A total of 866 elderly patients (430 men and 436 women, age: 65−98 years, mean age: 85 ± 10 years) were enrolled. Among these patients, 267 patients had acute non-ST-segment elevation MI (NSTEMI), 176 patients had acute CHF, 194 patients had acute AF and 229 patients were aged-matched healthy persons (CTR). All parameters were measured at the hospital admission and cardiovascular mortality was assessed during twenty-four months of follow-up. RESULTS The prevalence of anemia was higher in NSTEMI, CHF and AF patients compared to CTR subjects (50% vs. 15%, P < 0.05), with normocytic anemia being the most prevalent type (90%). Adjusted mortality risk was higher in anemic patient versus non-anemic patient in all the groups of patients [NSTEMI: hazard ratio (HR) = 1.81, 95% CI: 1.06−2.13; CHF: HR = 2.49, 95% CI: 1.31−4.75; AF: HR = 1.98, 95% CI: 1.01−3.88]. Decreased hemoglobin levels (P = 0.001) and high reticulocyte index (P = 0.023) were associated with higher mortality in CVD patients. CONCLUSIONS The significant associations between CVD and anemia and the prognostic relevance of anemia for elderly patients with CVD were confirmed in this study. The presence of anemia in AF patients is associated with a two-fold increased mortality risk compared with non-anemic AF patients. Low hemoglobin and high reticulocyte count independently predict mortality in elderly patients with CVD.
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  • [1]
    Anía BJ, Suman VJ, Fairbanks VF, et al. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc 1997; 45: 825−831. doi: 10.1111/j.1532-5415.1997.tb01509.x
    Woodman R, Ferrucci L, Guralnik J. Anemia in older adults. Curr Opin Hematol 2005; 12: 123−128. doi: 10.1097/01.moh.0000154030.13020.85
    Davis RC, Hobbs FD, Kenkre JE, et al. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 2012; 14: 1553−1559. doi: 10.1093/europace/eus087
    Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012; 19: 133−140. doi: 10.1097/MOH.0b013e3283522471
    Girelli D, Marchi G, Camaschella C. Anemia in the elderly. Hemasphere 2018; 2: e40. doi: 10.1097/HS9.0000000000000040
    Riva E, Tettamanti M, Mosconi P, et al. Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study. Haematologica 2009; 94: 22−28. doi: 10.3324/haematol.13449
    Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005; 111: 2042−2049. doi: 10.1161/01.CIR.0000162477.70955.5F
    Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J 2000; 140: 878−885. doi: 10.1067/mhj.2000.111108
    Teng TH, Finn J, Hung J. Mild anaemia is associated with increased all-cause mortality in heart failure. Heart Lung Circ 2010; 19: 31−37. doi: 10.1016/j.hlc.2009.08.004
    McKechnie RS, Smith D, Montoye C, et al. Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation 2004; 110: 271−277. doi: 10.1161/01.CIR.0000134964.01697.C7
    Anand IS, Gupta P. Anemia and iron deficiency in heart failure: current concepts and emerging therapies. Circulation 2018; 138: 80−98. doi: 10.1161/CIRCULATIONAHA.118.030099
    Horwich TB, Fonarow GC, Hamilton MA, et al. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002; 39: 1780−1786. doi: 10.1016/S0735-1097(02)01854-5
    Alkhouli M, Friedman PA. Ischemic stroke risk in patients with nonvalvular atrial fibrillation: JACC review topic of the week. J Am Coll Cardiol 2019; 74: 3050−3065. doi: 10.1016/j.jacc.2019.10.040
    Singh SN, Tang XC, Singh BN, et al. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a veterans affairs cooperative studies program substudy. J Am Coll Cardiol 2006; 48: 721−730. doi: 10.1016/j.jacc.2006.03.051
    Sharma S, Gage BF, Deych E, et al. Anemia: an independent predictor of death and hospitalizations among elderly patients with atrial fibrillation. Am Heart J 2009; 157: 1057−1063. doi: 10.1016/j.ahj.2009.03.009
    World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization, 2011. (asscessed February 3, 2021).
    DiMarco JP, Flaker G, Waldo AL, et al. Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 2005; 149: 650−656. doi: 10.1016/j.ahj.2004.11.015
    Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893−2962. doi: 10.1093/eurheartj/ehw210
    Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267−315. doi: 10.1093/eurheartj/ehv320
    Olivieri F, Galeazzi R, Giavarina D, et al. Aged-related increase of high sensitive troponin T and its implication in acute myocardial infarction diagnosis of elderly patients. Mech Ageing Dev 2012; 133: 300−305. doi: 10.1016/j.mad.2012.03.005
    Silverberg DS, Wexler D, Iaina A, et al. The interaction between heart failure and other heart diseases, renal failure, and anemia. Semin Nephrol 2006; 26: 296−306. doi: 10.1016/j.semnephrol.2006.05.006
    Macciò A, Madeddu C. Management of anemia of inflammation in the elderly. Anemia 2012; 2012: 563251. doi: 10.1155/2012/563251
    Franceschi C, Capri M, Monti D, et al. Inflammaging and anti-inflammaging: a systemic perspective on aging and longevity emerged from studies in humans. Mech Ageing Dev 2007; 128: 92−105. doi: 10.1016/j.mad.2006.11.016
    Jeong SK, Cho YI, Duey M, et al. Cardiovascular risks of anemia correction with erythrocyte stimulating agents: should blood viscosity be monitored for risk assessment? Cardiovasc Drugs Ther 2010; 24: 151−160. doi: 10.1007/s10557-010-6239-7
    Gluba-Brzózka A, Franczyk B, Olszewski R, et al. The influence of inflammation on anemia in CKD patients. Int J Mol Sci 2020; 21: 725. doi: 10.3390/ijms21030725
    Prakash D. Anemia in the ICU: anemia of chronic disease versus anemia of acute illness. Crit Care Clin 2012; 28: 333−343, v. doi: 10.1016/j.ccc.2012.04.012
    Haslam A, Hausman DB, Johnson MA, et al. Prevalence and predictors of anemia in a population-based study of octogenarians and centenarians in Georgia. J Gerontol A Biol Sci Med Sci 2012; 67: 100−106. doi: 10.1093/gerona/glr151
    Morici N, Savonitto S, Murena E, et al. Causes of death in patients ≥ 75 years of age with non-ST-segment elevation acute coronary syndrome. Am J Cardiol 2013; 112: 1−7. doi: 10.1016/j.amjcard.2013.02.043
    Westenbrink BD, Voors AA, de Boer RA, et al. Bone marrow dysfunction in chronic heart failure patients. Eur J Heart Fail 2010; 12: 676−684. doi: 10.1093/eurjhf/hfq061
    An Y, Ogawa H, Esato M, et al. Cardiovascular events and mortality in patients with atrial fibrillation and anemia (from the Fushimi AF Registry). Am J Cardiol 2020; 134: 74−82. doi: 10.1016/j.amjcard.2020.08.009
    Tang WH, Tong W, Jain A, et al. Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure. J Am Coll Cardiol 2008; 51: 569−576. doi: 10.1016/j.jacc.2007.07.094
    Ang DS, Kao MP, Noman A, et al. The prognostic significance of early and late anaemia in acute coronary syndrome. QJM 2012; 105: 445−454. doi: 10.1093/qjmed/hcr258
    Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol 2018; 15: 505−522. doi: 10.1038/s41569-018-0064-2
    Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood 2018; 131: 505−514. doi: 10.1182/blood-2017-07-746446
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