Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction

Adam C. Salisbury, Karen P. Alexander, Kimberly J. Reid, Frederick A. Masoudi, Saif S. Rathore, Tracy Y. Wang, Richard G. Bach, Steven P. Marso, John A. Spertus, Mikhail Kosiborod

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Abstract

Background-Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA). Methods and Results-We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year. Conclusions-HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.

Original languageEnglish (US)
Pages (from-to)337-346
Number of pages10
JournalCirculation: Cardiovascular Quality and Outcomes
Volume3
Issue number4
DOIs
StatePublished - Jul 2010

Fingerprint

Anemia
Myocardial Infarction
Incidence
Hemorrhage
Health Status
Mortality
Hemoglobins
Confidence Intervals
Platelet Glycoprotein GPIIb-IIIa Complex
Cardiogenic Shock
Percutaneous Coronary Intervention
Chronic Renal Insufficiency
Acute Kidney Injury
Registries
Length of Stay
Hospitalization

Keywords

  • Anemia
  • Hemoglobin
  • Myocardial infarction
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. / Salisbury, Adam C.; Alexander, Karen P.; Reid, Kimberly J.; Masoudi, Frederick A.; Rathore, Saif S.; Wang, Tracy Y.; Bach, Richard G.; Marso, Steven P.; Spertus, John A.; Kosiborod, Mikhail.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 3, No. 4, 07.2010, p. 337-346.

Research output: Contribution to journalArticle

Salisbury, AC, Alexander, KP, Reid, KJ, Masoudi, FA, Rathore, SS, Wang, TY, Bach, RG, Marso, SP, Spertus, JA & Kosiborod, M 2010, 'Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction', Circulation: Cardiovascular Quality and Outcomes, vol. 3, no. 4, pp. 337-346. https://doi.org/10.1161/CIRCOUTCOMES.110.957050
Salisbury, Adam C. ; Alexander, Karen P. ; Reid, Kimberly J. ; Masoudi, Frederick A. ; Rathore, Saif S. ; Wang, Tracy Y. ; Bach, Richard G. ; Marso, Steven P. ; Spertus, John A. ; Kosiborod, Mikhail. / Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. In: Circulation: Cardiovascular Quality and Outcomes. 2010 ; Vol. 3, No. 4. pp. 337-346.
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abstract = "Background-Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA). Methods and Results-We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4{\%}) patients had HAA, of whom 348 (26.3{\%}) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33{\%} to 69{\%}; median rate ratio for HAA, 1.13; 95{\%} confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95{\%} confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year. Conclusions-HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.",
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AU - Alexander, Karen P.

AU - Reid, Kimberly J.

AU - Masoudi, Frederick A.

AU - Rathore, Saif S.

AU - Wang, Tracy Y.

AU - Bach, Richard G.

AU - Marso, Steven P.

AU - Spertus, John A.

AU - Kosiborod, Mikhail

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N2 - Background-Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA). Methods and Results-We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year. Conclusions-HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.

AB - Background-Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA). Methods and Results-We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year. Conclusions-HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.

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