The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
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DOI：
10.1093/eurheartj/ehl012
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发表时间：
2006-06-01
影响因子：
39.3
通讯作者：
Poole-Wilson, Philip A.
中科院分区：
文献类型：
--
作者：
Komajda, Michel;Anker, Stefan D.;Poole-Wilson, Philip A.
目的 贫血是慢性心力衰竭 (CHF) 的常见合并症。新发贫血 (NOA) 的预测因子及其长期预后价值，尤其是接受 β 受体阻滞剂治疗的患者，尚不清楚。 方法和结果 在 COMET 中，3029 名 NYHA II-IV 且 EF < 35% 的 CHF 患者被随机分配至卡维地洛或酒石酸美托洛尔，并平均随访 58 个月。在中心实验室随机测量血浆血红蛋白 (Hb) 浓度，第一年每隔四个月测量一次，此后每年测量一次。根据世界卫生组织的标准，当男性 Hb 测量值 < 13 g/dL、女性 Hb 测量值 < 12 g/dL 时，即可定义为贫血。当男性 Hb < 11.5 g/dL 和女性 < 10.5 g/dL 时，我们认为贫血严重。基线平均 Hb 为 14.2 +/- 1.5 g/dL (n = 2996)，15.9% 的患者患有贫血（男性，16.0%；女性，15.2%）。基线时，3.3% 的患者发现严重贫血（男性，3.6%；女性，2.0%）。在研究期间，与非贫血患者相比，贫血患者的全因死亡率（RR 1.47）死亡或住院（RR 1.28）和心力衰竭住院（RR 1.43，所有 P < 0.0001）较高。在基线时没有贫血的患者中，研究结束时，男性 NOA 累积频率为 28.1%，女性为 27.0%。 NOA 随着时间的推移从第 1 年的 14.2% 增加到第 5 年的 27.5%。NOA 的预测因素包括：较高年龄、利尿剂剂量、肌酐（所有 P < 0.0001）、较高血清钾、较低血清钠、体重指数以及使用醛固酮拮抗剂、卡维地洛和洋地黄（所有 P < 0.03）。卡维地洛（与酒石酸美托洛尔相比）治疗与发生 NOA 的风险增加 24% 相关（P = 0.0047），但与严重贫血无关（P = 0.18）。与 Hb 增加 0-1.0 g/dL 的患者相比，Hb 较基线下降 > 3 g/dL（RR 3.37，P < 0.0001）或 2.0-3.0 g/dL（RR 1.47，P = 0.011）的患者随后的死亡率增加。变量。随着时间的推移，血红蛋白的下降与未来发病率和死亡率的增加有关。
Aims Anaemia is a common comorbidity in chronic heart failure (CHF). The predictors of new onset anaemia (NOA) and its long-term prognostic value, particularly in patients treated with beta-blockers, are not known.Methods and results In COMET, 3029 patients with CHF in NYHA II-IV and EF < 35% were randomized to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Plasma haemoglobin (Hb) concentrations were measured at a central laboratory at randomization, at four monthly intervals for the first year and annually thereafter. According to WHO criteria, anaemia was defined when Hb measured < 13 g/dL for men and < 12 g/dL for women. We considered anaemia to be severe when Hb < 11.5 g/dL for men and < 10.5 g/dL for women. The baseline mean Hb was 14.2 +/- 1.5 g/dL (n = 2996) and 15.9% of patients had anaemia (males, 16.0%; females, 15.2%). At baseline, severe anaemia was found in 3.3% of patients (males, 3.6%; females, 2.0%). During the study, all-cause mortality (RR 1.47) death or hospitalization (RR 1.28), and heart failure hospitalization (RR 1.43, all P < 0.0001) were higher in anaemic when compared with non-anaemic patients. In patients without anaemia at baseline, at the end of the study, the cumulative frequency of NOA was 28.1% in males and 27.0% in females. NOA increased over time from 14.2% at year 1 to 27.5% at year 5. Predictors of NOA were: higher age, diuretic dose, creatinine (all P < 0.0001), higher serum potassium, lower serum sodium, body mass index, and use of aldosterone antagonists, carvedilol, and digitalis (all P < 0.03). Treatment with carvedilol (vs. metoprolol tartrate) was associated with a 24% increased risk to develop NOA (P = 0.0047), but not severe anaemia (P = 0.18). Patients with a Hb decrease of > 3 g/dL (RR 3.37, P < 0.0001) or of 2.0-3.0 g/dL (RR 1.47, P = 0.011) from baseline had an increased subsequent mortality when compared with patients having Hb increases of 0-1.0 g/dL.Conclusion In stable ambulatory CHF patients, development of NOA is frequent and can be predicted by a set of clinical variables. Decreases in Hb over time relate to future increased morbidity and mortality.