The Association Between Anemia, Hospitalization, and All-cause Mortality in Patients with Heart Failure Managed in Primary Care: An Analysis of the Swedish Heart Failure Registry

Background: Many patients with heart failure (HF) are managed in primary care, and comorbidities are common. Anemia is one frequent comorbidity. The aim of this study was to assess the prevalence, comorbidities, and prognosis of HF patients in primary care who have anemia.

Method: We linked data on 9300 patients managed in primary care from the nationwide SwedeHF registry with other Swedish national register data. A multivariable logistic regression model with anemia as a dependent variable was performed. Multivariate Cox proportional hazards regression analysis was used to model the time to event.

Results: The median age (IQR) was 81 (74-86) years, and 45 % of the patients were female. A total of 2852 (30.7 %) had anemia. Anemia was more common in men, in those ≥75 years, and in those with kidney dysfunction. A total of 695 (10.8 %) of patients without and 520 (18.2 %) with anemia had cancer. Cancer was independently associated with anemia (OR 1.5, 95 % CI 1.3-1.7). Other comorbidities significantly associated with anemia were peripheral artery disease (OR 1.39, 95 % CI 1.18-1.65), diabetes (OR 1.29, 95 % CI 1.16-1.44), and liver disease (OR 1.64, 95 % CI 1.09-2.46). If anemia was present, prognosis was worse. Risk of all-cause hospitalization was higher (adjusted HR 1.3, 95 % CI 1.2-1.4), as was risk of all-cause mortality (adjusted HR 1.4, 95 % CI 1.3-1.5).

Conclusions: Anemia is common in primary care patients with HF. It is associated with worse prognosis and comorbidities, most notably cancer.