Risultati per: Anemia sideropenica e carenza marziale senza anemia: senza ferro si sta male

Besigye, secondo la moglie, era stato sequestrato in Kenya

Circulation, Volume 150, Issue Suppl_1, Page A4139144-A4139144, November 12, 2024. Background:Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF).Methods:Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts.Results:Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000).Conclusion:HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.

Circulation, Volume 150, Issue Suppl_1, Page A4147741-A4147741, November 12, 2024. Introduction:Anemia (males: [Hb]

Circulation, Volume 150, Issue Suppl_1, Page A4141624-A4141624, November 12, 2024. Introduction:It is estimated that about 30% of patients with heart failure (HF) have iron deficiency anemia that can be masked as chronic normocytic anemia or functional anemia. Currently, the ACC/AHA 2022 heart failure guidelines give IV Iron replacement a Class IIa recommendation. However, many physicians who are regularly involved in the management of HF patients do not assess for or adequately treat iron deficiency anemia in these patients. This project seeks to identify the gaps in physicians’ knowledge on iron deficiency anemia and HF.Method:Over a 2-week period, a 9-item questionnaire was given to a total of 52 Internal Medicine physicians: 9 attendings, 27 residents (2nd and 3rd year) and 16 interns (1st year residents) chosen by convenience sampling. The participants at that time, were regularly involved in the care of patients with HF at a Brooklyn inter-city community Hospital. Data was collected and analyzed using IBM SPSS version 29 data analysis software.Results:All 52 participants completed the survey. When asked if all stages and classification of heart failure can be affected by iron deficiency anemia, 81.3% of interns vs 100% of both residents and attendings answered yes. However, only 18.8% of interns, 22.2% of residents and 11.1% of attendings test every patient with HFrEF

Circulation, Volume 150, Issue Suppl_1, Page A4144763-A4144763, November 12, 2024. Background:Anemia is frequently observed as a comorbidity in atrial fibrillation (AF) and is associated with poor clinical outcomes.Purpose:We aim to investigate the impact of anemia on clinical outcomes in AF Patients on oral anticoagulants.Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024 and conducted a prognostic systematic review and meta-analysis. All analyses were performed using R V. 4.3.1.Results:With the inclusion of 23 studies, our cohort comprised a total of 286,781 patients. Anemia was significantly associated with an 86% increase in the risk of major bleeding (HR: 1.86 with 95% CI [1.61, 2.14], P< 0.01), a 25% increase in the risk of intracranial hemorrhage (HR: 1.25 with 95% CI [1.02, 1.54], P= 0.03), a 92% increase in the risk of gastrointestinal bleeding (HR: 1.92 with 95% CI [1.68, 2.19], P< 0.01), and a 91% increase in the risk of all-cause mortality (HR: 1.91 with 95% CI [1.46, 2.51], P< 0.01). However, Anemia did not significantly affect the risk of stroke, TIA, or systemic embolism (HR: 1.07 with 95% CI [0.93, 1.22], P= 0.36).Conclusion:Anemia was significantly associated with an increased risk of major bleeding, intracerebral hemorrhage, gastrointestinal bleeding, and all-cause mortality without impacting stroke, TIA, or systemic embolism. Further research is warranted to compare the effects of DOACs and vitamin K antagonists. Clinically, it is imperative to closely monitor the anemic status of patients due to these elevated risks.

Circulation, Volume 150, Issue Suppl_1, Page A4145056-A4145056, November 12, 2024. Introduction:Iron deficiency anemia (IDA) affects millions of people with heart failure (HF) and is of a higher proportion in patients admitted for HF than those seen as an outpatient. The cause of IDA in patients with HF is postulated to be related to the chronic inflammatory process that occurs resulting in decreased erythropoiesis. This could also be a side effect of the extensive treatment. The fate of patients admitted for exacerbation of heart failure, especially those with IDA could be fatal. This study uses the NIS HCUP database to assess the outcome of patients admitted from 2016 to 2019 with heart failure and co-existing iron deficiency anemia.Research question/ hypothesis:Patients with HF and co-existing IDA have worse outcomes than those without.Method:We used the NIS HCUP 2016 to 2019 database for the analysis. The primary outcome was inpatient mortality. Secondary outcomes such as mean length of hospitalization (LOS), mean total hospital charges (THC) adjusted for inflation and proportion of complications were computed. Data was analyzed using regression models adjusted for significant, confounding, sociodemographic and comorbid conditions.Discussion/ Results::The total population of hospitalizations for HF from 2016 to 2019 was 1270784 with 6.9% having IDA. A higher proportion of hospitalizations with IDA were women. The mortality from the HF admission was 39350 patients. IDA was associated with lower adjusted odds of inpatient mortality (2.5 vs 3.2%, aOR: 0.75, 95% confidence interval (CI) of 0.68-0.84. However, patients with IDA had significantly longer mean LOS and higher THC compared to patients without IDA. Patients with IDA also had increased adjusted odds or requiring pressors, developing acute kidney failure and respiratory failure.Conclusion::Although IDA did not appear to impact mortality in patients with HF, it was associated with higher inpatient complications and higher healthcare cost utilization. Researchers postulate that limitation of different codes being used when data is recorded could have contributed to the unimpacted mortality. Further studies are needed to decipher other factors. Addressing comorbid IDA in the outpatient setting may significantly decrease the cost associated with hospitalization for HF by decreasing the length of hospitalization and the hospital charges associated with those hospitalizations.

Circulation, Volume 150, Issue Suppl_1, Page A4146340-A4146340, November 12, 2024. Background:Iron deficiency anemia (IDA) is a common comorbidity in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). This study investigates the differences in outcomes between TAVI patients with and without IDA, focusing on mortality, procedural complications, and baseline characteristics.Methods:A retrospective analysis was conducted using data from the National Inpatient Sample (NIS) from 2016 to 2021. The outcomes for patients undergoing TAVI with IDA were compared to those without IDA. Multivariate logistic regression was employed to analyze outcomes.Results:The study included 367,440 patients without iron deficiency anemia and 16,030 patients with iron deficiency anemia. Baseline characteristics showed a significant difference in gender distribution, with 47.15% of IDA patients being male compared to 56.4% in the non-IDA group (P < 0.0001). Racial distribution varied significantly (P < 0.0001), with a higher % of Black patients in the IDA group (6.16% vs. 3.97%).Patients with IDA had higher odds of heart block (OR: 1.146, 95% CI: 1.061-1.238, P = 0.001), bleeding (OR: 1.229, 95% CI: 1.115-1.355, P < 0.001), transfusion (OR: 2.487, 95% CI: 2.209-2.800, P < 0.001), prosthetic dysfunction (OR: 1.377, 95% CI: 1.053-1.801, P = 0.02), post-procedure shock (OR: 1.450, 95% CI: 1.180-1.782, P < 0.001), intra-procedure shock (OR: 1.562, 95% CI: 1.264-1.931, P < 0.001), dialysis (OR: 1.450, 95% CI: 1.044-2.015, P = 0.027), atrial fibrillation (OR: 1.115, 95% CI: 1.033-1.204, P = 0.005), cardiogenic shock (OR: 1.587, 95% CI: 1.283-1.963, P < 0.001), sepsis (OR: 1.541, 95% CI: 1.122-2.117, P = 0.008), respiratory failure (OR: 1.635, 95% CI: 1.462-1.828, P < 0.001), and myocardial infarction (OR: 1.684, 95% CI: 1.421-1.996, P < 0.001). Patients with IDA had a longer length of stay (Coefficient: 2.067, 95% CI: 1.798-2.337, P < 0.001) and higher total hospital charges (Coefficient: $23,107, 95% CI: $16,471-$29,742, P < 0.001) compared to those without IDA.Conclusions:Patients with IDA undergoing TAVI are at higher risk for several complications, including heart block, bleeding, transfusion, prosthetic dysfunction, post-procedure and intra-procedure shock, dialysis, atrial fibrillation, cardiogenic shock, sepsis, respiratory failure, and myocardial infarction compared to those without IDA. These findings underscore the need for targeted management strategies and further research to optimize outcomes for TAVI patients with iron deficiency anemia.

Circulation, Volume 150, Issue Suppl_1, Page A4141968-A4141968, November 12, 2024. Background:Each heart failure (HF) hospitalization is associated with significant morbidity and mortality, reduced quality of life, and extensive use of healthcare resources. Iron deficiency anemia (IDA) frequently coexists with heart failure, exacerbating therapeutic outcomes and reducing patients’ overall quality of life.Hypothesis:IDA increases the rate of overall rehospitalization in HFrEF patients.Aim:Assess the influence of IDA on rehospitalization rates among patients with HFrEF.Methods:A retrospective analysis was performed on adult patients at a Metroplex Health System in Arizona who had an ICD code of HFrEF between January 2016 and December 2017. The primary endpoint was all causes rehospitalization within 1- and 12-months post-discharge. The relationship between IDA and all causes rehospitalization was assessed using multivariate logistic regression, while adjusting for potential confounders.Results:Among 1,083 patients diagnosed with HFrEF, 115 (10.62%) had IDA. The mean age (SD) and BMI (SD) of the IDA group were 64.02 (14.59) years and 29.62 (8.22) kg/m2, respectively, with 69.57% being male and 52.17% non-Hispanic white. After adjusting for age, race, gender, diabetes, hypertension, dyslipidemia, coronary artery disease, and cerebrovascular disease, the competing risk survival analysis revealed a statistically significant increase in hospital readmission rates at 12 months for IDA (adjusted subhazard ratio [aSHR]: 1.78, 95% CI: 1.38-2.30, p < 0.001) and native American ethnicity (aSHR: 1.56, 95% CI: 1.056-2.311 p = 0.026). While the rate of rehospitalization at 1 month did not achieve statistical significance (aSHR: 1.19, 95% CI: 0.723-1.956, p = 0.491).Conclusion:Patients with HFrEF and IDA have higher all-cause hospital readmission rates within 12 months, highlighting the importance of managing IDA in HFrEF treatment. Addressing IDA may reduce rehospitalization burden and improve long-term outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4119891-A4119891, November 12, 2024. Background:Endothelin receptor antagonists (ERAs) demonstrated significant efficiency in delaying clinical deterioration and improving survival of patients with pulmonary arterial hypertension (PAH). However, the frequent occurrence of anemia after ERAs administration has gained clinical attention currently, whereas the etiology of anemia is unclear. The risk factors of ERAs associated anemia remained undefined. Therefore, we aim to investigate risk factors of developing anemia after ERAs treatment and whether iron supplement could correct anemia.Method:A retrospective cohort study was performed among patients with PAH who received ERAs between January, 2017 and December, 2019 in Fuwai hospital. The primary outcome was development of anemia after ERAs therapy and secondary outcome was correction of anemia after iron supplement.Results:A total of 120 patients with PAH were included in the study and 28 patients developed anemia during follow up.Distinctively, all the patients who developed anemia were female. After ERAs administration, iron metabolism (Ferritin 95.29±144.79 μg/L versus 69.9±118.25 μg/L,P

Circulation, Volume 150, Issue Suppl_1, Page A4145632-A4145632, November 12, 2024. Background:High circulating levels of galectin-3 are associated with all-cause and cardiovascular (CV) mortality in patients with coronary artery disease (CAD). However, the impact of anemia on the prediction of galectin-3 with cause-specific mortality in patients with suspected or known CAD is unknown.Methods:Serum levels of galectin-3 were measured in 2,418 patients with suspected or known CAD undergoing elective coronary angiography. The outcomes were all-cause death, CV death, and non-CV death. Patients were divided into 2 groups according to the presence (n=882) or absence (n=1,536) of anemia, and followed up over a 6-year period.Results:During the follow-up, 329 anemic and 207 non-anemic patients died of any cause, 116 anemic and 50 non-anemic patients died of CV diseases, and 187 anemic and 139 non-anemic patients died of non-CV diseases. After adjustment for potential clinical confounders and established CV biomarkers, log-transformed (Ln-) galectin-3 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.23; 95% confidence interval [CI], 1.10–1.37) and non-CV death (HR, 1.30; 95% CI, 1.13–1.50), but not with CV death (HR, 1.16; 95% CI, 0.95–1.41) in the entire cohort; significantly associated with all-cause death (HR, 1.20; 95% CI, 1.03–1.41) and non-CV death (HR, 1.49; 95% CI, 1.20–1.85), but not with CV death (HR, 0.95; 95% CI, 0.72–1.24), in anemic patients; and significantly associated with all-cause death (HR, 1.33; 95% CI, 1.13–1.57) and CV death (HR, 1.19; 95% CI, 1.00–1.42), but not with non-CV death (HR, 1.17; 95% CI, 0.95–1.43), in non-anemic patients. We also evaluated the incremental predictive performance of galectin-3 by calculating continuous net reclassification improvement, and integrated discrimination improvement metrics. The addition of Ln-galectin-3 levels to the model with potential clinical confounders and established CV biomarkers further improved the prediction of all-cause death and non-CV death, but not that of CV death, in the entire cohort and in anemic patients, and the prediction of all-cause death and CV death, but not that of non-CV death, in non-anemic patients.Conclusions:In patients with suspected or known CAD, distinct differences were observed between anemic and non-anemic patients, in the prediction for cause-specific mortality by galectin-3 levels, which independently predicted non-CV mortality in anemic patients and CV mortality in non-anemic patients.

Annals of Internal Medicine, Ahead of Print.

Osservatorio Nomisma, per 8 medicinali su 10 esiste l’equivalente

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

The US Preventive Services Task Force (USPSTF) recently released a Recommendation Statement examining the data to support screening for iron deficiency anemia in pregnancy and finding them lacking. It also found insufficient evidence to make a clear recommendation for or against preventive iron supplementation in pregnancy, which has been a routine practice for decades, with up to 77% to 89% of patients reporting supplement use. As highlighted previously by the USPSTF and others, there is an urgent need for studies and clinical trials to support evidence-based medicine in the obstetric population, and this can only be accomplished by ceasing paternalistic approaches that have led to the exclusion of pregnant patients in research. All of this remains true, and there is still so very far to go.

This JAMA Patient Page discusses the pros and cons of screening for iron deficiency and iron deficiency anemia during pregnancy.