Polycythemia is not associated with increased mortality in heart failure

1. Polycythemia was not associated with increased in-hospital, short-term, or long-term mortality.

Evidence Rating Level: 2 (Good)

Anemia has been consistently associated with worse outcomes in both chronic heart failure and acute decompensated HF (ADHF). Polycythemia has been linked to adverse outcomes in acute coronary syndrome (ACS), but whether a similar association exists for ADHF. This study thus examined the clinical profile and prognostic implications of polycythemia in patients hospitalized with ADHF. This retrospective cohort study included adult patients >18 years hospitalized with ADHF between 2007 and 2017. Patients were categorized by hemoglobin levels: anemic (<13 g/dL men, < 12 g/dL women), normocythemic, or polycythemic (>18.5 g/dL men, > 16.5 g/dL women). Patients were matched 1:3:3 into polycythemia, normocythemia, and anemia groups. The primary outcomes were in-hospital mortality, 30-day readmission, and long-term 1- and 5-year survival. Of the 8,332 patients included in the study, 5,615 (67.4%) had anemia (mean [SD] age = 77.3 [11.5], 2677 [47.7%] female), 2,639 (31.7%) normocythemia, (mean [SD] age = 74.4 [12.9], 1427 [54.1%] female) and 78 (0.9%) polycythemia (mean [SD] age = 67.5 [13.3], 20 [25.6%] female). In the matched cohort of 546 patients (234 anemic, 234 normocythemic, 78 polycythemic), in-hospital mortality rates were similar (5.6%, 3.8%, 7.7%; p = 0.381). One-year mortality was highest in anemia (27.4%) compared with normocythemia (17.5%) and polycythemia (19.2%) (p = 0.030). Five-year survival was poorest in anemia, while it was similar for polycythemia and normocythemia (log-rank p = 0.027). Compared with normocythemia, anemia was associated with higher long-term mortality (HR 1.30, 95% CI 1.03–1.63), whereas polycythemia was not (HR 0.90, 95% CI 0.64–1.27). The 30-day readmission rate was lower in the polycythemia group (9.6%) compared with the anemia and normocythemia groups (20.6%), although this difference was not statistically significant (p = 0.084). Overall, this study found that unlike anemia, polycythemia was not associated with increased in-hospital, short-term, or long-term mortality, suggesting that polycythemia may not serve as a negative prognostic marker in this setting.

Click here to read the study in PLOS One

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