The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial

Abdulla A. Damluji, Conrad Macon, Arieh Fox, Grettel Garcia, Mohammed S. Al-Damluji, George R. Marzouka, Robert J. Myerburg, Ian C. Gilchrist, Mauricio G. Cohen, Mauro Moscucci

Research output: Contribution to journalArticle

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Abstract

Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined 433 patients enrolled in the ESCAPE trial. Results Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1 g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p = 0.011), had lower systolic BP (mm Hg) (99 vs. 106, p = 0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p = 0.025), higher BUN (mg/dL) (37 vs. 26, p < 0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p < 0.001) and higher hospital length of stay (10 days vs. 6 days, p = < 0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2 g/dL: 10% versus 3%, p = 0.010; 3 g/dL: 5% versus 0%, p = 0.005). After adjustments, a drop of hemoglobin with at least 1 g/dL was associated with increased mortality risk (Adjusted HR 2.38, p = 0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p = 0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1 g/dL: 1.88, p = 0.043; Hb Drop 2 g/dL: 3.6 p = 0.025). Conclusion In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

Original languageEnglish (US)
Pages (from-to)531-537
Number of pages7
JournalInternational Journal of Cardiology
Volume222
DOIs
StatePublished - Nov 1 2016

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Hemoglobins
Heart Failure
Mortality
Pulmonary Artery
Length of Stay
Catheters
Blood Urea Nitrogen
Creatinine
Sodium
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Damluji, Abdulla A. ; Macon, Conrad ; Fox, Arieh ; Garcia, Grettel ; Al-Damluji, Mohammed S. ; Marzouka, George R. ; Myerburg, Robert J. ; Gilchrist, Ian C. ; Cohen, Mauricio G. ; Moscucci, Mauro. / The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure : Results from the ESCAPE trial. In: International Journal of Cardiology. 2016 ; Vol. 222. pp. 531-537.
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abstract = "Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined 433 patients enrolled in the ESCAPE trial. Results Of the 433 patients, 324 (75{\%}) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20{\%}) had at least 1 g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p = 0.011), had lower systolic BP (mm Hg) (99 vs. 106, p = 0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p = 0.025), higher BUN (mg/dL) (37 vs. 26, p < 0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p < 0.001) and higher hospital length of stay (10 days vs. 6 days, p = < 0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2 g/dL: 10{\%} versus 3{\%}, p = 0.010; 3 g/dL: 5{\%} versus 0{\%}, p = 0.005). After adjustments, a drop of hemoglobin with at least 1 g/dL was associated with increased mortality risk (Adjusted HR 2.38, p = 0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p = 0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of {\%} change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1 g/dL: 1.88, p = 0.043; Hb Drop 2 g/dL: 3.6 p = 0.025). Conclusion In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.",
author = "Damluji, {Abdulla A.} and Conrad Macon and Arieh Fox and Grettel Garcia and Al-Damluji, {Mohammed S.} and Marzouka, {George R.} and Myerburg, {Robert J.} and Gilchrist, {Ian C.} and Cohen, {Mauricio G.} and Mauro Moscucci",
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The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure : Results from the ESCAPE trial. / Damluji, Abdulla A.; Macon, Conrad; Fox, Arieh; Garcia, Grettel; Al-Damluji, Mohammed S.; Marzouka, George R.; Myerburg, Robert J.; Gilchrist, Ian C.; Cohen, Mauricio G.; Moscucci, Mauro.

In: International Journal of Cardiology, Vol. 222, 01.11.2016, p. 531-537.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure

T2 - Results from the ESCAPE trial

AU - Damluji, Abdulla A.

AU - Macon, Conrad

AU - Fox, Arieh

AU - Garcia, Grettel

AU - Al-Damluji, Mohammed S.

AU - Marzouka, George R.

AU - Myerburg, Robert J.

AU - Gilchrist, Ian C.

AU - Cohen, Mauricio G.

AU - Moscucci, Mauro

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined 433 patients enrolled in the ESCAPE trial. Results Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1 g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p = 0.011), had lower systolic BP (mm Hg) (99 vs. 106, p = 0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p = 0.025), higher BUN (mg/dL) (37 vs. 26, p < 0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p < 0.001) and higher hospital length of stay (10 days vs. 6 days, p = < 0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2 g/dL: 10% versus 3%, p = 0.010; 3 g/dL: 5% versus 0%, p = 0.005). After adjustments, a drop of hemoglobin with at least 1 g/dL was associated with increased mortality risk (Adjusted HR 2.38, p = 0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p = 0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1 g/dL: 1.88, p = 0.043; Hb Drop 2 g/dL: 3.6 p = 0.025). Conclusion In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

AB - Introduction The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. Methods We examined 433 patients enrolled in the ESCAPE trial. Results Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1 g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p = 0.011), had lower systolic BP (mm Hg) (99 vs. 106, p = 0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p = 0.025), higher BUN (mg/dL) (37 vs. 26, p < 0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p < 0.001) and higher hospital length of stay (10 days vs. 6 days, p = < 0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2 g/dL: 10% versus 3%, p = 0.010; 3 g/dL: 5% versus 0%, p = 0.005). After adjustments, a drop of hemoglobin with at least 1 g/dL was associated with increased mortality risk (Adjusted HR 2.38, p = 0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p = 0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1 g/dL: 1.88, p = 0.043; Hb Drop 2 g/dL: 3.6 p = 0.025). Conclusion In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

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