Journal of Experimental Medical & Surgical Research
JOURNAL of
Cercetãri Experimentale & Medico-Chirurgicale
Experimental
Year XVII · Nr.4/2010 · Pag.305 - 307
Medical
Surgical
R E S E A R C H
ANEMIA IN HOSPITALIZED PATIENTS WITH SEVERE
HEART FAILURE
S. Laicu1,
T. Ciocârlie1,
R. Avram1,
F. Pârv1,
M. Balint1,
I. Avram2
SUMMARY:
We proposed the investigation of anaemia as comorbidity in patients with severe heart
failure. We studied a total of 214 patients hospitalized with heart failure stage III and IV
NYHA and EF <40% of which 66 were documented with anaemia, in which we investigated
demographic data, clinical, laboratory, diagnosis of associated chronic diseases. Kidney
involvement was documented in 40% of cases, 30% had severe anaemia, a result of both
losses and lack of intake. Anaemia often accompanies impaired systolic function, iron
deficiency and chronic kidney disease are common, therapeutic evaluation and correction
of anaemia has important prognostic implications.
Key-words: heart failure, anaemia, ejection fraction.
REZISTENÞA LA QUINOLONE A UNOR TULPINI DE ENTEROBACTERIACEAE IZOLATE
DIN INFECÞIILE TRACTULUI URINAR ÎNTR-O SECÞIE DE TERAPIE INTENSIVÃ
Received for publication: 11.10.2010
Revised: 02.11.2010
REZUMAT:
Ne-am propus investigarea anemiei, ca ºi comorbiditate la pacienþii cu forme severe de
insuficienþã cardiacã. Am luat în studiu un numãr de 214 pacienþi spitalizaþi cu insuficienþã
cardiacã NYHA III ºi IV ºi FE < 40% din care la 66 s-a documentat anemia, la care am
investigat datele demografice, clinice, paraclinice. Afectarea renalã s-a documentat la 40%
din cazuri, 30% au prezentat anemie severã, în egalã mãsurã consecinþã a pierderilor ºi a
lipsei de aport. Anemia însã este adesea alterarea funcþiei sistolice, deficitul de fier ºi boala
cronicã renalã sunt frecvente, evaluarea anemiei ºi corecþia terapeuticã au implicaþii
prognostice importante.
Cuvinte cheie: insuficienþã cardiacã, anemie, fracþie de ejecþie.
1 – Cardiology Department, Emergency County Hospital Timisoara
2 – 1st Surgical Department, Emergency County Hospital Timisoara
INTRODUCTION
Recent literature draws attention to a haematology
pathology associated with heart failure - anaemia common comorbidity, it can compete in worsening
symptoms and may also be responsible for the
rehospitalisation of the patient.
The prevalence of anaemia in patients with heart
failure is important to be known, the quality of life, the
exercise capacity can be improved by appropriate
therapy and its correction. We proposed the evaluation of
anaemia in relation to the classification in degrees of
severity of heart failure symptoms, signs,
echocardiographic
medication.
examination,
aetiology
and
MATERIAL AND METHOD
We studied patients with heart failure hospitalized
within a year in the cardiology department. Of the 368
patients, we selected 214 who had clinical events
included in that heart failure NYHA III and IV and ejection
fraction <40%.
The causes of heart failure have been classified hypertension, coronary disease, valvular heart disease.
We evaluated the clinical presentation, presence of
Correspondence to: Simina Laicu, [email protected]
305
stasis rales, hepatomegaly, stasis and cardiomegaly at
radiological examination, ECG abnormalities. We
evaluated the renal function, the thyroid and
gastrointestinal function in order to diagnose the
presence of comorbidities.
We took into account haemoglobin values below
12g/dL in men and 11.5g/dl in women and serum iron
values.
RESULTS
Of the 214 patients with heart failure NYHA III and IV
and ejection fraction below 40%, 66 had a haemoglobin
value that confirmed anaemia as the aetiology of heart
failure: 24 had coronary artery disease, 20 valvular
disease, 22 were hypertensive; 3 patients associated
hyperthyroid and 21 chronic obstructive pulmonary
disease. Diabetes mellitus was associated in 34 patients.
(Figure.1)
Renal failure was recorded as comorbidity in 29
patients. Iron deficiency was documented in 32 patients,
in 10 a source of bleeding was confirmed gastrointestinal in 7, genital in 2, kidney in 1. (Figure.2,
Figure.3)
DISCUSSION
Anaemia was present in a significant percentage of
patients with advanced clinical forms of heart failure - 66
of 214, an association commonly noted in the literature
(1).
In one third of patients - iron deficiency anaemia type
was documented in 22, of which only 10 had a
documented cause for bleeding.
Chronic renal failure is frequently a cause of anaemia
(2) frequent another does not seem to have etiological
features in heart failure that accompanies anaemia.
Fig. 1. Comorbidities
Fig. 2. Iron deficiency
306
suggests an aggravating comorbidity for both anaemia
and heart failure.
In the absence of a proper anaemia correction, the
prognosis is questionable both in young people with
impaired diastolic function (3) but also in those with
impaired systolic function (4) (5).
CONCLUSIONS
Fig. 3. Source of bleeding
Resuming patient history, in 11 patients the iron
deficiency component is likely through food intake,
suggesting a more complex deficiency, including lack of
care and is a possible contributory cause of aggravation
and readmission of patients.
Mental component of anxiety and / or depression was
diagnosed in 9 patients by psychiatric test, which also
Our study suggests that anaemia is a common
comorbidity associated with heart failure, regardless of
cause. Iron deficiency due to loss or lack of food intake is
common in relation to a digestive disease and a
psychiatric one. Among the chronic diseases, chronic
renal failure seems to be the most common.
Diagnosis of anaemia, of cause, clinical form,
comorbidities and their correction, improves their
prognosis and reduces hospital readmissions for heart
failure.
References:
1. Thon T, Haase M, Rosamond V, Howard VD – American Heart Association Statistics Committee Circulation 2006, 113, 85-151
2. McChellan WM, Flanders WD – Anaemia and renal insufficiency are independent risk factors for death among patients with
congestive heart failure admitted to community hospitals J.Am. Soc. Nephrol. 2002, 13, 1928-36
3. Brucks S, Little WC, Chao T – Relation of anaemia to diastolic heart failure and the effect on outcome Am.J.Cardiol. 2004, 93,
1055-57
4. Felker GM, Shaw LK, Stough WG – Anaemia in patients with heart failure and reserved systolic function Am.Heart J. 2006, 151,
457-462
5. Kosibarad M, Smith GL, Radford MJ – The prognostic compliance of anaemia in patients with congestive heart failure admitted to
community hospitals – J.Am.Soc.Nephrol. 2002, 13, 1928-36.
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