PURPOSE: Anemia has been shown to be associated with increased risk of morbidity and mortality in patients with chronic heart failure (CHF). Beta blockers have been shown to decrease mortality and morbidity in CHF. However, utilization of beta blockers in patients with anemia and CHF is not clear.
METHODS: In 274 consecutive patients enrolled in a large tertiary care Heart Failure program, we evaluated the relationship between use of diuretics, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and beta blockers (BB) in patients with New York Heart Association Class (NYHA) III and IV. The utilization of these medications was analyzed at different hemoglobin levels.
RESULTS: Anemia was present in 38.7% of patients (Hbc 12.5 gm/dl in male, <12 gm/dl in females) of which 46% and 52% were in NYHA Class III and IV respectively. Diuretic use at enrollment was 73.7% overall with no difference between groups with Hb <12.5 gm/dl and >12.5 gm/dl (p=0.3). ACEI/ARB use was 54.7% with no difference between groups with anemia and without (p=0.54). BB use was 62% overall with 58% use in patients with Hb <12.5 gm/dl compared to 65% use in patients with Hb >12.5 gm/dl (p=0.02). Over a 2 year follow up period, there were 62 deaths. Of these, 29 died of CHF complications, 28 non CHF, 1 unknown and 4 sudden death. Of the 62 patients who died, 29 patients ( 46% ) had anemia (Hb <12.5gm/dl).
CONCLUSION: 1. Beta blocker utilization is low in patients with anemia and CHF. This may be partially due to intolerance of beta blockers in patients with low hemoglobin. 2. Mortality in CHF patients may be accelerated by prevalence of anemia.
CLINICAL IMPLICATIONS: Correction of anemia may lead to better beta blocker utilization and survival; hence further studies are warranted to assess survival with use of Erythropoietin or Darbopoietin in patients with anemia and chronic heart failure.
DISCLOSURE: Krishnaswami Vijayaraghavan, None.