Original Article
Impact of Anaemia on Mortality and its Causes in Elderly Patients with Acute Coronary Syndromes

https://doi.org/10.1016/j.hlc.2014.12.004Get rights and content

Background

Prognostic impact of anaemia in the elderly with acute coronary syndromes has not been specifically analysed, and little information exists about causes of mortality in this setting.

Methods

We prospectively included consecutive patients with acute coronary syndromes. Anaemia was defined as haemoglobin < 130 g/L in men, and < 120 g/L in women. Primary outcome was mid-term mortality and its causes. Analyses were performed by Cox regression method.

Results

We included 2128 patients, of whom 394 (18.6%) were aged 75 years or older. Anaemia was more common in the elderly (40.4% vs 19.5%, p <0.001). Mean follow-up was 386 days. Anaemia independently predicted overall mortality (HR 1.47, 95% CI 1.05-2.06), cardiac mortality (HR 1.76, 95% CI 1.06-2.94) and non-cardiac mortality (HR 1.59, 95% CI 1.03-2.45) in the overall cohort. In young patients the association between anaemia and mortality was significant only for non-cardiac causes. The association between anaemia and mortality was not significant in the elderly (HR 1.08, 95% CI 0.71-1.63, p 0.736).

Conclusions

The impact of anaemia on cause specific of mortality seem to be different according to age subgroup. The association between anaemia and mortality was not observed in elderly patients from our series.

Introduction

Anaemia is a common comorbidity among patients with acute coronary syndromes (ACS) [1] and is associated with higher mortality in this clinical setting [2]. The exact mechanisms to explain this association remain unclear. Although anaemia may reduce oxygen delivery to the myocardium, thus increasing cardiovascular events, patients with anaemia are usually older, with more comorbidities that could also increase mortality due to non-cardiac diseases. Little information exists about cause specific mortality in ACS patients with anaemia.

On the other hand, frailty and comorbidities are common in elderly patients with ACS, making management and risk stratification difficult in this clinical scenario [3]. Information about the prognostic impact of anaemia in the elderly with ACS is scarce. The aim of the present study was to prospectively assess the impact of anaemia in overall mortality and its causes, in consecutive patients with ACS and also specifically in the elderly.

Section snippets

Study Design and Population

This is an observational single centre registry, which was conducted at a tertiary care Hospital in Spain (Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona). All consecutive ACS patients admitted to the Coronary Care Unit between October 2009 and April 2014 were prospectively included. Informed consent was provided by all patients before their inclusion in the study. The confidential information of the patients was protected according to current national normative. This

Results

During the study period, 2128 ACS patients were admitted with mean age of 62.3 years. Almost 80% of patients were male. Table 1 shows baseline and clinical characteristics, management and clinical course of the overall cohort. Anaemia at admission was present in 497 patients (23.4%). Patients with anaemia were significantly older, with higher prevalence of cardiovascular risk factors and other comorbidities. Significant differences regarding clinical presentation were also found. Patents with

Discussion

The main findings from our study are: a) anaemia behaved as an independent predictor of mortality in our patients, and causes of mortality seem to be different regarding age subgroup, and b) the association between anaemia and mortality was not observed in elderly patients from our series.

Anaemia is a common comorbidity in ACS, and is strongly associated with higher mortality and morbidity in this setting [2], [9], [10], [11] and also in other diseases, such as heart failure [12] or kidney

Conclusions

Anaemia was a common comorbidity in elderly ACS patients from our series. The impact of anaemia on cause specific of mortality seems to be different according to age subgroup. We did not observe a significant association between anaemia and mortality in the elderly. Routine assessment of ageing related variables such as frailty and comorbidities may be useful to better understand the role of anaemia in risk stratification of elderly patients with ACS.

Disclosures

None declared.

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