Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure

Ashkan Yadollahi Farsani, Mehrbod Vakhshoori, Asieh Mansouri, Maryam Heidarpour, Farnoosh Nikouei, Mohammad Garakyaraghi, Nizal Sarrafzadegan, Davood Shafie

Abstract


Background: Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF.

Methods: This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively.

Results: The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07–1.18, P = 0.08).

Conclusions: Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population‑based studies are necessary proving these associations.


Keywords


Anemia; heart failure; hemoglobins; hospitalization; patient admission

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References


Alexandrakis MG, Tsirakis G. Anemia in heart failure patients.

ISRN Hematol 2012;2012:9.

Luthi JC, Flanders WD, Burnier M, Burnand B, McClellan WM.

Anemia and chronic kidney disease are associated with poor

outcomes in heart failure patients. BMC Nephrol 2006;7:3.

Lam CS. Heart failure in Southeast Asia: Facts and numbers.

ESC Heart Fail 2015;2:46‑9.

Roger VL. Epidemiology of heart failure. Circ Res

;113:646‑59.

Chong AY, Rajaratnam R, Hussein NR, Lip GY. Heart failure in

a multiethnic population in Kuala Lumpur, Malaysia. Eur J Heart

Fail 2003;5:569‑74.

Nordyke RJ, Kim JJ, Goldberg GA, Vendiola R, Batra D,

McCamish M, et al. Impact of anemia on hospitalization time,

charges, and mortality in patients with heart failure. Value Health

;:464‑71.

Givi M, Shafie D, Garakyaraghi M, Yadegarfar G, Roohafza HR,

Ahmadi SA, et al. Patients characteristics and preliminary

outcomes of heart failure registry in a middle‑income country:

Persian registry of cardiovascular disease/heart failure

(PROVE/HF). Galen Med J 2018;2018;7. Epub 2018‑03‑31.

Givi M, Shafie D, Nouri F, Garakyaraghi M, Yadegarfar G,

Sarrafzadegan N. Survival rate and predictors of mortality in

patients hospitalised with heart failure: A cohort study on the

data of Persian registry of cardiovascular disease (PROVE).

Postgrad Med J 2018;94:318‑24.

Fujita T, Inomata T, Yazaki M, Iida Y, Kaida T, Ikeda Y, et al.

Hemodilution after initial treatment in patients with acute

decompensated heart failure. Int Heart J 2018;59:573‑9.

Boyle A, Sobotka PA. Redefining the therapeutic objective in

decompensated heart failure: Hemoconcentration as a surrogate

for plasma refill rate. J Card Fail 2006;12:247‑9.

Zhou H, Xu T, Huang Y, Zhan Q, Huang X, Zeng Q, et al.

The top tertile of hematocrit change during hospitalization is

associated with lower risk of mortality in acute heart failure

patients. BMC Cardiovasc Disord 2017;17:235.

Darawsha W, Chirmicci S, Solomonica A, Wattad M, Kaplan M,

Makhoul BF, et al. Discordance between hemoconcentration and

clinical assessment of decongestion in acute heart failure. J Card

Fail 2016;22:680‑8.

Damluji AA, Macon C, Fox A, Garcia G, Al‑Damluji MS,

Marzouka GR, et al. The association between in‑hospital

hemoglobin changes, cardiovascular events, and mortality in

acute decompensated heart failure: Results from the ESCAPE

trial. Int J Cardiol 2016;222:531‑7.

van der Meer P, Postmus D, Ponikowski P, Cleland JG,

O’Connor CM, Cotter G, et al. The predictive value of

short‑term changes in hemoglobin concentration in patients

presenting with acute decompensated heart failure. J Am Coll

Cardiol 2013;61:1973‑81.

Davila C, Reyentovich A, Katz SD. Clinical correlates

of hemoconcentration during hospitalization for acute

decompensated heart failure. J Card Fail 2011;17:1018‑22.

Givi M, Sarrafzadegan N, Garakyaraghi M, Yadegarfar G,

Sadeghi M, Khosravi A, et al. Persian registry of cardiovascular

disease (PROVE): Design and methodology. ARYA Atheroscler

;13:236‑44.

Testani JM, Brisco MA, Chen J, McCauley BD, Parikh CR,

Tang WW. Timing of hemoconcentration during treatment of acute

decompensated heart failure and subsequent survival: Importance

of sustained decongestion. J Am Coll Cardiol 2013;62:516‑24.

Ter Maaten JM, Valente MA, Damman K, Cleland JG,

Givertz MM, Metra M, et al. Combining diuretic response and

hemoconcentration to predict rehospitalization after admission

for acute heart failure. Circ Heart Fail 2016;9:e002845.

Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP.

Potential effects of aggressive decongestion during the treatment

of decompensated heart failure on renal function and survival.

Circulation 2010;122:265‑72.

Oh J, Kang SM, Hong N, Youn JC, Han S, Jeon ES, et al.

Hemoconcentration is a good prognostic predictor for clinical

outcomes in acute heart failure: Data from the Korean Heart

Failure (KorHF) Registry. Int J Card 2013;168:4739‑43.