Background: Anemia is common in patients with HF with a prevalence ranging from 10-40%. Studies have shown that these patients have worse outcomes compared to those who don’t. The most common etiology remains iron deficiency and the updated 2017 HF guidelines state that for those patients who are diagnosed with iron deficiency anemia, intravenous iron is recommended. The purpose of this study was to evaluate the prevalence, management, and impact of anemia in a predominantly Mexican American underserved population of HF patients.
Methods: We performed a retrospective chart review, of patients admitted with a diagnosis of HF (HFpEF, HFrEF or combined) during the year 2017 to a community hospital in South Texas. Patients charts were reviewed for comorbid conditions, laboratory data and anemia diagnoses and treatments. Outcomes were assessed as readmission rates and death within 1 year from index admission. Definitions were used according to preestablished guidelines.
Results: A total of 320 patients were evaluated. The average age was 71 ± 14, 121 (38%) were female, 229 (72%) Mexican-American and average BMI was 31 ± 7. 118 (37%) patients had HFrEF and 102 (32%) had HFpEF. 218 (68%) had coronary artery disease, 280 (88%) hypertension, 188 (59%) diabetes mellitus, and 149 (47%) had chronic kidney disease. Of 320 patients that were evaluated, 185 (58%) had anemia with a mean hemoglobin level of 10 ± 1mg/dl, and hematocrit 31 ± 1 mg/dl . Anemia was more common in Hispanics (76% vs 65%), females (45% vs 27%), with HFpEF (36% vs 26%) and CKD (56% vs 33%).Our findings showed that only 68 (37%) patients with anemia underwent appropriate evaluation during index admission. Treatments included: PRBCs transfusion in 39 patients, EPO administration in 5 patients, intravenous iron in 30 patients and oral iron in 10 patients.
Of the 68 patients that had formal evaluation the most common diagnosis was iron deficiency anemia followed by anemia of inflammation (75% vs 25%). Mortality and readmission rates were higher in patients with anemia ( 5.4% vs 2.9% and 34% vs 31 % respectively).
Conclusions: There is a higher prevalence of anemia in heart failure patients in this cohort compared to that reported in the literature. Also we demonstrate that evaluation and management of anemia in the inpatient setting remains suboptimal. Our management often did not follow the guidelines, using cutoffs that trigger parenteral iron supplementation that are different from non-HF patients. Mortality and readmission rates were higher in our anemic patients. Additionally, in an observational basis we notice improvement in quality of life when anemia is optimally treated, similar to the literature Therefore, substantial opportunity for improvement exists and addressing this gap in diagnosis and treatment has a potential to reduce readmission rates and improve quality of life for our HF patients with anemia.