10.24265/horizmed.2024.v24n2.16
Letter the
Editor
Prognostic value
of the influence of anemia
on heart failure
Jennifer Quispe-Medina 1 0009-0002-0487-9561
Mirko Juárez-Chacón 1 0009-0001-5774-1286
Pedro Chunga-Tume 10000-0001-8169-0768
1 Universidad Privada San Juan Bautista, School of Human
Medicine. Lima, Peru.
*Corresponding author
Dear Editor: The article by Guevara et al. contains
an interesting analysis
of the pathophysiological relationship between hemoglobin deficiency and heart failure (HF). It mentions
that despite the numerous studies
on the influence of anemia on
HF-related morbidity and mortality, there
is no consensus on the prognostic value
of this disease
on HF (1). However, several studies address the prognostic value
of the influence of anemia
on HF, which we would
like to reference.
The study developed by Bichara et al. demonstrated the risk of death from chronic HF in patients with anemia, specifically in patients with systolic HF, with a 3 % increase in death related
to hematocrit levels.
Nonetheless, it remains
uncertainty as to whether
the relationship between
these two pathological conditions is causal or merely a risk factor. It should
be noted that, in patients with anemia, a hemoglobin (Hb) value < 13 g/dL is
a direct predictor of HF and can involve multiple pathophysiological factors-among which
the most important is to transport oxygen to target
organs, including the heart
and kidneys-covertly related
to renal failure,
thus worsening the clinical presentation in hospitalized patients. In addition to this,
there are secondary factors such as ejection fraction
and chronic kidney
disease (CKD), considered as indirect indicators of HF that lead to a less favorable
prognosis (2).
Furthermore, García et al. conducted a study to analyze the etiology of anemia in HF, particularly to assess the importance of the prognostic value
for anemia regarding HF. They analyzed
a group of medical records
from 272 patients
with Hb < 12
g/dL and found that 39.9 % of the patients
admitted for HF had anemia.
It was also observed that this could
be associated with older adults from 82.1 ± 9 years of age and multiple
other factors, such as ischemic heart disease (15 %), hypertensive
heart disease (34 %), valvular
heart disease (14 %) and hospital readmissions. However, in concurrent studies, anemia and patients with HF have been linked to the role of erythropoietin in CKD, with a mortality rate prognosis of 15 % (3).
On the other hand, in their study, Sánchez et al. reported that anemia was associated with high rates of cardiac mortality, particularly in female patients
(65.7 %) and older patients
(74 ± 2 years). Observational studies and a multivariate analysis revealed the occurrence of anemia as a condition with a poorer
prognosis for patients
with HF. Anemia was identified as a predictor of mortality (19.89/100), and each gram decrease
in Hb increases the risk of death
by up to 20.5 % (4).
In conclusion, there is a prognostic value
of mortality for patients with anemia who present with HF; the analyzed studies determined that this mortality
rate exceeds 3 % and is related
to the severity of anemia.
Therefore, it is possible to state
that there are prognostic factors,
such as morbidity and mortality
of HF in these cases.
Likewise, other factors
such as age should be considered, as well as other comorbidities that could introduce biases in the bivariate analysis
of this prognostic relationship.
BIBLIOGRAPHIC REFERENCES
1.Guevara A. Riesgo de muerte por insuficiencia cardiaca congestiva en pacientes anémicos
de la población peruana. Horiz Med
[Internet]. 2023;1(1):2-3.
2.Bichara VM. Anemia como indicador
pronóstico en insuficiencia cardíaca. Insuf card [Internet]. 2016;11(2):69-73.
3.García de Casasola G, Cárdenas Franco C, Vegas Serrano A, Hornero
Izquierdo MA, Guijarro Herraiz C, Zapatero Gaviria A. La anemia es un factor pronóstico de mortalidad en la insuficiencia cardíaca. An Med Interna [Internet].
2005;22(6):271-4.
4.Sánchez-Torrijos J, Gudín-Oriel M, Nadal-Barangé M, Jacas-Osborn V, Trigo-Bautista A, Giménez-Alcalá
M, et al. Valor pronóstico de las cifras
de hemoglobina en el momento del alta en pacientes
hospitalizados por insuficiencia cardiaca. Rev Esp Cardiol [Internet]. 2006;59(12):1276-82.
*Corresponding author:
Pedro Chunga Tume
Address: Ex Hacienda Villa,
Av. José Antonio
Lavalle s/n. Lima, Perú.
Telephone: +51 945 502 563
Correo electrónico: pedro.chunga@upsjb.edu.pe
Author contributions: JQM, MJCh and PCht contributed to searching for information to write and analyze the article.
Funding sources: This article was funded by the authors.
Conflicts of interest: The authors
declare no conflict of interest.
Reception
date:
November 30, 2023
Evaluation
date:
December 6, 2023
Approval
date:
December 6, 2023