Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East

Mohammed Al-Jarallah, Rajesh Rajan, Ibrahim Al-Zakwani, Raja Dashti, Bassam Bulbanat, Kadhim Sulaiman, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Mustafa Ridha, Nooshin Bazargani, Nidal Asaad, Haitham Amin

Research output: Contribution to journalArticle

Abstract

Aims: This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Methods and results: Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re-admission rate for AHF at 3 months' follow-up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow-up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all-cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow-up (aOR, 1.48; 95% CI: 1.07–2.06; P = 0.018), and at 12 months' follow-up (aOR, 1.45; 95% CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all-cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20–3.45; P = 0.009) and at 12 months' follow-up (aOR, 1.42; 95% CI: 1.06–1.89; P = 0.019) but not at 3 months' follow-up (aOR, 1.43; 95% CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all-cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84–5.55; P = 0.113) but also at 3 months' follow-up (aOR, 1.87; 95% CI: 0.93–3.76; P = 0.078) and at 12 months' follow-up (aOR, 1.59; 95% CI: 0.91–2.76; P = 0.101). Conclusions: The incidence of CRAS was 27%. CRAS was associated with higher odds of all-cause mortality in AHF patients in the Middle East, especially in those with HFrEF.

Original languageEnglish
JournalESC heart failure
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Cardio-Renal Syndrome
Middle East
Stroke Volume
Anemia
Heart Failure
Odds Ratio
Confidence Intervals
Mortality
Incidence
Hospital Mortality
Bahrain
Qatar
Yemen
United Arab Emirates
Oman
Kuwait
Saudi Arabia
Glomerular Filtration Rate
Blood Transfusion
Coronary Artery Disease

Keywords

  • Arabian Gulf
  • Cardiorenal syndrome
  • Chronic kidney disease
  • Heart failure
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East. / Al-Jarallah, Mohammed; Rajan, Rajesh; Al-Zakwani, Ibrahim; Dashti, Raja; Bulbanat, Bassam; Sulaiman, Kadhim; Alsheikh-Ali, Alawi A.; Panduranga, Prashanth; AlHabib, Khalid F.; Al Suwaidi, Jassim; Al-Mahmeed, Wael; AlFaleh, Hussam; Elasfar, Abdelfatah; Al-Motarreb, Ahmed; Ridha, Mustafa; Bazargani, Nooshin; Asaad, Nidal; Amin, Haitham.

In: ESC heart failure, 01.01.2018.

Research output: Contribution to journalArticle

Al-Jarallah, M, Rajan, R, Al-Zakwani, I, Dashti, R, Bulbanat, B, Sulaiman, K, Alsheikh-Ali, AA, Panduranga, P, AlHabib, KF, Al Suwaidi, J, Al-Mahmeed, W, AlFaleh, H, Elasfar, A, Al-Motarreb, A, Ridha, M, Bazargani, N, Asaad, N & Amin, H 2018, 'Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East', ESC heart failure. https://doi.org/10.1002/ehf2.12351
Al-Jarallah, Mohammed ; Rajan, Rajesh ; Al-Zakwani, Ibrahim ; Dashti, Raja ; Bulbanat, Bassam ; Sulaiman, Kadhim ; Alsheikh-Ali, Alawi A. ; Panduranga, Prashanth ; AlHabib, Khalid F. ; Al Suwaidi, Jassim ; Al-Mahmeed, Wael ; AlFaleh, Hussam ; Elasfar, Abdelfatah ; Al-Motarreb, Ahmed ; Ridha, Mustafa ; Bazargani, Nooshin ; Asaad, Nidal ; Amin, Haitham. / Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East. In: ESC heart failure. 2018.
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title = "Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East",
abstract = "Aims: This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Methods and results: Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62{\%} (n = 3081) were men, and 27{\%} (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61{\%}), coronary artery disease (n = 2971; 60{\%}), and diabetes mellitus (n = 2449; 50{\%}). A total of 79{\%} (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50{\%}). CRAS patients were associated with major bleeding (1.29{\%} vs. 0.6{\%}; P = 0.017), blood transfusion (10.1{\%} vs. 3.0{\%}; P < 0.001), higher re-admission rate for AHF at 3 months' follow-up (27.6{\%} vs. 18.8{\%}; P < 0.001) and at 12 months' follow-up (34.3{\%} vs. 26.2{\%}; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all-cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95{\%} confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow-up (aOR, 1.48; 95{\%} CI: 1.07–2.06; P = 0.018), and at 12 months' follow-up (aOR, 1.45; 95{\%} CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all-cause mortality during hospital admission (aOR, 2.03; 95{\%} CI: 1.20–3.45; P = 0.009) and at 12 months' follow-up (aOR, 1.42; 95{\%} CI: 1.06–1.89; P = 0.019) but not at 3 months' follow-up (aOR, 1.43; 95{\%} CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50{\%}), CRAS was not associated with higher odds of all-cause mortality not only during hospital admission (aOR, 2.15; 95{\%} CI: 0.84–5.55; P = 0.113) but also at 3 months' follow-up (aOR, 1.87; 95{\%} CI: 0.93–3.76; P = 0.078) and at 12 months' follow-up (aOR, 1.59; 95{\%} CI: 0.91–2.76; P = 0.101). Conclusions: The incidence of CRAS was 27{\%}. CRAS was associated with higher odds of all-cause mortality in AHF patients in the Middle East, especially in those with HFrEF.",
keywords = "Arabian Gulf, Cardiorenal syndrome, Chronic kidney disease, Heart failure, Mortality",
author = "Mohammed Al-Jarallah and Rajesh Rajan and Ibrahim Al-Zakwani and Raja Dashti and Bassam Bulbanat and Kadhim Sulaiman and Alsheikh-Ali, {Alawi A.} and Prashanth Panduranga and AlHabib, {Khalid F.} and {Al Suwaidi}, Jassim and Wael Al-Mahmeed and Hussam AlFaleh and Abdelfatah Elasfar and Ahmed Al-Motarreb and Mustafa Ridha and Nooshin Bazargani and Nidal Asaad and Haitham Amin",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/ehf2.12351",
language = "English",
journal = "ESC heart failure",
issn = "2055-5822",
publisher = "The Heart Failure Association of the European Society of Cardiology",

}

TY - JOUR

T1 - Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East

AU - Al-Jarallah, Mohammed

AU - Rajan, Rajesh

AU - Al-Zakwani, Ibrahim

AU - Dashti, Raja

AU - Bulbanat, Bassam

AU - Sulaiman, Kadhim

AU - Alsheikh-Ali, Alawi A.

AU - Panduranga, Prashanth

AU - AlHabib, Khalid F.

AU - Al Suwaidi, Jassim

AU - Al-Mahmeed, Wael

AU - AlFaleh, Hussam

AU - Elasfar, Abdelfatah

AU - Al-Motarreb, Ahmed

AU - Ridha, Mustafa

AU - Bazargani, Nooshin

AU - Asaad, Nidal

AU - Amin, Haitham

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Aims: This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Methods and results: Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re-admission rate for AHF at 3 months' follow-up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow-up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all-cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow-up (aOR, 1.48; 95% CI: 1.07–2.06; P = 0.018), and at 12 months' follow-up (aOR, 1.45; 95% CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all-cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20–3.45; P = 0.009) and at 12 months' follow-up (aOR, 1.42; 95% CI: 1.06–1.89; P = 0.019) but not at 3 months' follow-up (aOR, 1.43; 95% CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all-cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84–5.55; P = 0.113) but also at 3 months' follow-up (aOR, 1.87; 95% CI: 0.93–3.76; P = 0.078) and at 12 months' follow-up (aOR, 1.59; 95% CI: 0.91–2.76; P = 0.101). Conclusions: The incidence of CRAS was 27%. CRAS was associated with higher odds of all-cause mortality in AHF patients in the Middle East, especially in those with HFrEF.

AB - Aims: This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Methods and results: Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re-admission rate for AHF at 3 months' follow-up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow-up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all-cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow-up (aOR, 1.48; 95% CI: 1.07–2.06; P = 0.018), and at 12 months' follow-up (aOR, 1.45; 95% CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all-cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20–3.45; P = 0.009) and at 12 months' follow-up (aOR, 1.42; 95% CI: 1.06–1.89; P = 0.019) but not at 3 months' follow-up (aOR, 1.43; 95% CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all-cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84–5.55; P = 0.113) but also at 3 months' follow-up (aOR, 1.87; 95% CI: 0.93–3.76; P = 0.078) and at 12 months' follow-up (aOR, 1.59; 95% CI: 0.91–2.76; P = 0.101). Conclusions: The incidence of CRAS was 27%. CRAS was associated with higher odds of all-cause mortality in AHF patients in the Middle East, especially in those with HFrEF.

KW - Arabian Gulf

KW - Cardiorenal syndrome

KW - Chronic kidney disease

KW - Heart failure

KW - Mortality

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U2 - 10.1002/ehf2.12351

DO - 10.1002/ehf2.12351

M3 - Article

AN - SCOPUS:85054860195

JO - ESC heart failure

JF - ESC heart failure

SN - 2055-5822

ER -