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Open AccessArticle

Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain
Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain
Cardiology Hospital Clínico de Valencia, 46010 Valencia, Spain
CIBERObn Carlos III Institute Madrid, 28029 Madrid, Spain
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1869;
Received: 28 April 2020 / Revised: 9 June 2020 / Accepted: 11 June 2020 / Published: 15 June 2020
(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)
Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up. View Full-Text
Keywords: heart failure; anemia; blood loss; acute kidney injury; hospitalization; mortality heart failure; anemia; blood loss; acute kidney injury; hospitalization; mortality
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Lopez, C.; Holgado, J.L.; Fernandez, A.; Sauri, I.; Uso, R.; Trillo, J.L.; Vela, S.; Bea, C.; Nuñez, J.; Ferrer, A.; Gamez, J.; Ruiz, A.; Redon, J. Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study. J. Clin. Med. 2020, 9, 1869.

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