Anemia Carries Consequences for TAVR Patients
Nearly two-thirds of TAVR patients have anemia before or after their procedure, according to a study published online November 29, 2014, ahead of print in the American Journal of Cardiology. The condition correlates with poor functional status at baseline and at 6 months.
Nine in 10 cases are treatable, and half arise primarily from iron deficiency, report Josep Rodés-Cabau, MD, and colleagues at the Quebec Heart and Lung Institute, Laval University (Quebec City, Canada).
The researchers analyzed results of 438 consecutive patients (mean age 79) undergoing TAVR at their center between May 2007 and December 2013. Anemia—defined as a hemoglobin level < 12 g/dL in women and < 13 g/dL in men—was found in 64.4% of patients before TAVR and in 62% of patients at 6-months postprocedure.
Baseline anemia was associated with poorer functional status prior to TAVR (table 1).
Patients found to have anemia 6 months after TAVR also had poorer function at follow-up, although the differences were attenuated (table 2).
By 6 months, 52 patients (11.9%) had died. Anemia as a whole was not associated with increased mortality risk, but in patients with baseline diagnosis of severe anemia—defined as < 10 g/dL—survival was lower than in those without severe anemia at 6 months (75.7% vs 88.6%) and at 12 months (69.2% vs 84.1%; log-rank P = .005).
In a subset of 114 patients, 90.4% had a potentially correctable cause for anemia. Iron-deficiency anemia was confirmed in 52.6% and possible iron deficiency in 18.4%. Other diagnoses included chronic renal failure and vitamin B12 deficiency.
Is Anemia Overlooked?
Anemia’s prevalence and its apparent effects on outcome suggest that a relatively simple intervention could lead to better results for patients, said Dr. Rodés-Cabau. “After a successful TAVR procedure, some patients do not experience any significant improvement in quality of life, and anemia can be one of the factors associated with this lack of improvement,” he told TCTMD in an email. “It is not infrequent that anemia is overlooked and undertreated, especially among elderly patients.”
The potential for side effects could at least partly explain the reduced prescription rate for iron therapy before TAVR and hospital discharge, the paper notes, adding that the optimal therapy for anemic patients in this setting needs further evaluation.
Limitations of the study include the lack of a prespecified treatment protocol for anemia, the authors acknowledge, as well as the lack of a robust evaluation of response to iron therapy. Also, data on functional outcomes were not available for patients who died within the first 6 months after TAVR, raising the possibility that anemia’s impact could have been underestimated.
“The main contribution of this study is [its] analysis of reasons for anemia,” Eugenia Nikolsky, MD, PhD, of Rambam Medical Center (Haifa, Israel), told TCTMD in an email. Iron deficiency, she said, “is an easily treatable condition, and correction of iron stores may really improve the prognosis of patients, especially of those with congestive heart failure.” She noted that iron is now recommended by European Society of Cardiology guidelines for treatment of chronic heart failure.
DeLarochellière H, Urena M, Amat-Santos IJ, et al. Effect on outcomes and exercise performance of anemia in patients with aortic stenosis undergoing transcatheter aortic valve replacement. Am J Cardiol. 2014;Epub ahead of print.
- Dr. Rodés-Cabau reports serving as a consultant for Edwards Lifesciences and St. Jude Medical.
- Dr. Nikolsky reports no relevant conflicts of interest.