Incidence, Correlates, and Outcomes of Acute, Hospital-Acquired Anemia in Patients With Acute Myocardial Infarction
- 1 July 2010
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Quality and Outcomes
- Vol. 3 (4), 337-346
- https://doi.org/10.1161/circoutcomes.110.957050
Abstract
Background—: Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA). Methods and Results—: We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year. Conclusions—: HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.Keywords
This publication has 24 references indexed in Scilit:
- Definition, Incidence, Correlates, and Clinical Impact of “Nuisance” Bleeding in Patients Undergoing Drug-Eluting Stent ImplantationThe American Journal of Cardiology, 2009
- Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trialEuropean Heart Journal, 2009
- Baseline Risk of Major Bleeding in Non–ST-Segment–Elevation Myocardial InfarctionCirculation, 2009
- Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removalCatheterization and Cardiovascular Interventions, 2006
- The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?Blood, 2006
- Impact of Bleeding Severity on Clinical Outcomes Among Patients With Acute Coronary SyndromesThe American Journal of Cardiology, 2005
- Relation of Anemia at Discharge to Survival After Acute Coronary SyndromesThe American Journal of Cardiology, 2005
- A Validated Prediction Model for All Forms of Acute Coronary SyndromeJAMA, 2004
- Modelling covariance structure in the analysis of repeated measures dataStatistics in Medicine, 2000
- A 12-Item Short-Form Health SurveyMedical Care, 1996