Methods: A cross-sectional study design was used. We enrolled 298 patients with HF from outpatient cardiology clinics at an academic-affiliated hospital in Cheonan, South Korea. The institutional research board of Soonchunhyang University Hospital in Cheonan approved the study protocol. We obtained socio-demographic and clinical information, including frequencies of readmissions and ED visits, using face-to-face interviews and medical record reviews. In this study, anemia was defined for adult men and women according to the criteria of the World Health Organization as a hemoglobin concentration lower than 13.0 g/dL in men and 12.0 g/dL in women. The data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY). P values of <0.05 were considered statistically significant. In order to investigate the association between anemia and readmission or ED visits, we adopted a multiple logistic regression model adjusting for age, gender, job, duration of diagnosed HF, NYHA class, hyperlipidemia, use of angiotensin-converting enzyme (ACE) inhibitors, and EF.
Results: The prevalence of anemia as assessed using modified World Health Organization guidelines was 111/284 (39.1%) in outpatients with HF. Anemia were significantly more prevalent in patients who were aged 65 and older (p < 0.001), those who had no monthly income (p = 0.004), those whose HF was diagnosed for one year or longer prior to their visit (p = 0.014), those with chronic renal failure (CRF) as a comorbidity (p = 0.012), and those with less than 40% of the EF of patients without anemia (p = 0.019). Anemia was also significantly more prevalent in patients with BMI (p = 0.001) and diastolic blood pressure (DBP) (p = 0.002), and those with higher BNP (p = 0.024), BUN (p < 0.001), and Cr (p < 0.001) levels than patients without anemia.
In adjusted multiple logistic regression, anemia was 8.04 times more prevalent (95% confidence interval [CI], 2.19-29.54] in patients readmitted to hospitals. Anemia was also 2.37 times more prevalent (95% CI, 1.22-4.60) in patients visiting the ED.
Conclusion: In conclusion, although cardiovascular nurses and allied professionals are aware of the importance of the assessment and treatment of anemia in patients with HF, their specific knowledge on this subject could be improved. Thorough nursing assessments and appropriate nursing interventions are imperative in safeguarding patients with HF presenting with anemia. Future prospective studies targeting interventions to improve anemic conditions are needed to determine whether anemia influences readmission rates and ED visits.