Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry

Mamas A Mamas, Chun Shing Kwok, Evangelos Kontopantelis, Anthony A. Fryer, Iain Buchan, Max O Bachmann, M. Justin Zaman, Phyo K. Myint

Research output: Contribution to journalArticle

19 Citations (Scopus)
5 Downloads (Pure)

Abstract

Background: We aim to determine the prevalence of anemia in ACS patients and compared their clinical characteristics, management and clinical outcomes to those without anemia in an unselected national ACS cohort.
Methods and Results: The Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30-day mortality with 1 g/dl incremental hemoglobin increase and the 30-days and 1-year mortality for anemic compared to non-anemic groups. Analyses were adjusted for covariates. Our analysis of 422,855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic, and that these patients are older, have a greater prevalence renal disease, peripheral vascular disease, diabetes mellitus and previous acute myocardial infarction and are less likely to receive evidence based therapies shown to improve clinical outcomes. Finally our analysis suggests that anemia is independently associated with 30-day (OR 1.28, 95%CI 1.22-1.35) and 1-year mortality (OR 1.31, 95%CI 1.27-1.35) and we observed a reverse J-shaped relationship between hemoglobin levels and mortality outcomes.
Conclusion: The prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multi-morbid, and less likely to receive evidence-based therapies shown to improve clinical outcomes with the presence of anemia independently associated mortality outcomes.
Original languageEnglish
Article number003348
JournalJournal of the American Heart Association
Volume5
Issue number11
DOIs
Publication statusPublished - 19 Nov 2016

Fingerprint

Acute Coronary Syndrome
Myocardial Ischemia
Registries
Anemia
Mortality
Hemoglobins
Peripheral Vascular Diseases
Wales
England
Diabetes Mellitus
Cohort Studies
Retrospective Studies
Logistic Models
Myocardial Infarction
Kidney
Therapeutics

Keywords

  • acute coronary syndrome
  • anemia
  • mortality

Cite this

Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort : Insights From the UK Myocardial Ischemia National Audit Project Registry. / Mamas, Mamas A; Kwok, Chun Shing; Kontopantelis, Evangelos; Fryer, Anthony A.; Buchan, Iain; Bachmann, Max O; Zaman, M. Justin ; Myint, Phyo K.

In: Journal of the American Heart Association, Vol. 5, No. 11, 003348, 19.11.2016.

Research output: Contribution to journalArticle

Mamas, Mamas A ; Kwok, Chun Shing ; Kontopantelis, Evangelos ; Fryer, Anthony A. ; Buchan, Iain ; Bachmann, Max O ; Zaman, M. Justin ; Myint, Phyo K. / Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort : Insights From the UK Myocardial Ischemia National Audit Project Registry. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 11.
@article{29177204ce21432db94510ade7b18123,
title = "Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry",
abstract = "Background: We aim to determine the prevalence of anemia in ACS patients and compared their clinical characteristics, management and clinical outcomes to those without anemia in an unselected national ACS cohort. Methods and Results: The Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30-day mortality with 1 g/dl incremental hemoglobin increase and the 30-days and 1-year mortality for anemic compared to non-anemic groups. Analyses were adjusted for covariates. Our analysis of 422,855 patients with ACS showed that 27.7{\%} of patients presenting with ACS are anemic, and that these patients are older, have a greater prevalence renal disease, peripheral vascular disease, diabetes mellitus and previous acute myocardial infarction and are less likely to receive evidence based therapies shown to improve clinical outcomes. Finally our analysis suggests that anemia is independently associated with 30-day (OR 1.28, 95{\%}CI 1.22-1.35) and 1-year mortality (OR 1.31, 95{\%}CI 1.27-1.35) and we observed a reverse J-shaped relationship between hemoglobin levels and mortality outcomes. Conclusion: The prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multi-morbid, and less likely to receive evidence-based therapies shown to improve clinical outcomes with the presence of anemia independently associated mortality outcomes.",
keywords = "acute coronary syndrome, anemia, mortality",
author = "Mamas, {Mamas A} and Kwok, {Chun Shing} and Evangelos Kontopantelis and Fryer, {Anthony A.} and Iain Buchan and Bachmann, {Max O} and Zaman, {M. Justin} and Myint, {Phyo K.}",
note = "The project was funded by the Halley Stewart Trust and the North Staffordshire Medical Institute. MRC Health eResearch Centre grant MR/K006665/1 supported the time and facilities of EK. MINAP is funded by the Health Quality Improvement Partnership (HQIP).",
year = "2016",
month = "11",
day = "19",
doi = "10.1161/JAHA.116.003348",
language = "English",
volume = "5",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort

T2 - Insights From the UK Myocardial Ischemia National Audit Project Registry

AU - Mamas, Mamas A

AU - Kwok, Chun Shing

AU - Kontopantelis, Evangelos

AU - Fryer, Anthony A.

AU - Buchan, Iain

AU - Bachmann, Max O

AU - Zaman, M. Justin

AU - Myint, Phyo K.

N1 - The project was funded by the Halley Stewart Trust and the North Staffordshire Medical Institute. MRC Health eResearch Centre grant MR/K006665/1 supported the time and facilities of EK. MINAP is funded by the Health Quality Improvement Partnership (HQIP).

PY - 2016/11/19

Y1 - 2016/11/19

N2 - Background: We aim to determine the prevalence of anemia in ACS patients and compared their clinical characteristics, management and clinical outcomes to those without anemia in an unselected national ACS cohort. Methods and Results: The Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30-day mortality with 1 g/dl incremental hemoglobin increase and the 30-days and 1-year mortality for anemic compared to non-anemic groups. Analyses were adjusted for covariates. Our analysis of 422,855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic, and that these patients are older, have a greater prevalence renal disease, peripheral vascular disease, diabetes mellitus and previous acute myocardial infarction and are less likely to receive evidence based therapies shown to improve clinical outcomes. Finally our analysis suggests that anemia is independently associated with 30-day (OR 1.28, 95%CI 1.22-1.35) and 1-year mortality (OR 1.31, 95%CI 1.27-1.35) and we observed a reverse J-shaped relationship between hemoglobin levels and mortality outcomes. Conclusion: The prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multi-morbid, and less likely to receive evidence-based therapies shown to improve clinical outcomes with the presence of anemia independently associated mortality outcomes.

AB - Background: We aim to determine the prevalence of anemia in ACS patients and compared their clinical characteristics, management and clinical outcomes to those without anemia in an unselected national ACS cohort. Methods and Results: The Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30-day mortality with 1 g/dl incremental hemoglobin increase and the 30-days and 1-year mortality for anemic compared to non-anemic groups. Analyses were adjusted for covariates. Our analysis of 422,855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic, and that these patients are older, have a greater prevalence renal disease, peripheral vascular disease, diabetes mellitus and previous acute myocardial infarction and are less likely to receive evidence based therapies shown to improve clinical outcomes. Finally our analysis suggests that anemia is independently associated with 30-day (OR 1.28, 95%CI 1.22-1.35) and 1-year mortality (OR 1.31, 95%CI 1.27-1.35) and we observed a reverse J-shaped relationship between hemoglobin levels and mortality outcomes. Conclusion: The prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multi-morbid, and less likely to receive evidence-based therapies shown to improve clinical outcomes with the presence of anemia independently associated mortality outcomes.

KW - acute coronary syndrome

KW - anemia

KW - mortality

U2 - 10.1161/JAHA.116.003348

DO - 10.1161/JAHA.116.003348

M3 - Article

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - 003348

ER -