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. Met...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.展开更多
文摘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.
