PREVALENCE OFANEMIA AND ASSOCIATED FACTORS AMONG ADULT PATIENTS WITH HEART FAILURE AT CARDIAC FOLLOW UP CLINIC OF ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIA FROM MAY 1 to JULY 30, 2021

Abstract

Abstract Background: Anemia is a common comorbidity in heart failure (HF) patients and its presence is associated with decreased functional capacity, poor quality of life and increased mortality. Previous studies showed the overall prevalence of anemia in HF patients ranges from 10-50% and in outpatient HF patients 25%. Older age, renal dysfunction, diabetes mellitus, male sex and worse New York heart association (NYHA) functional status were reported to be independently associated with anemia. Anemia is a prevalent problem in the in Ethiopian setting affecting 23% of reproductive age women, 18% of adult men. But data is lacking about its prevalence and factors associated with it in outpatient HF patients in our set up. Method: A hospital based cross-sectional study was conducted to assess the prevalence of anemia among outpatient HF patients at SPHMMC from May1-July 30, 2021. Systematic random sampling (k=6) was used to recruit study participants which were calculated to be 273. Interviewing and chart review were made using questionnaires containing socio-demographic characteristics, clinical and medication profiles, complete blood count (CBC), renal function test (RFT), ejection fraction (EF) and Kansas City cardiomyopathy questionnaire- 12 points (KCCQ-12). STATA version 13 software was used to get descriptive statistics results and to see the association of variables which was assessed using bivariate and multivariate binary logistic regression model. Results: Among respondents, 68(26.2%) patients had anemia. The majority (91%) had ≥mild anemia (Hgb 10-11.9g/dl for females and 10-12.9 g/dl for males). The mean Hgb in the anemic group was 11.4 ± 1g/dl as compared to 14.6 ± 1.5g/dl in the non-anemic group. The mean age of respondents was 55.68 ± 17 years and majority were females (52.7%). In multivariable binary logistic regression analysis, the odds of having anemia in those HF patients with NYHA functional class III was 6 times higher than those with NYHA class I (AOR=6.05, P=0.004, 95% CI 1.8-20.33). Compared to those HF patients who had diabetes mellitus, those who didn’t have were about 79% less likely to develop anemia (AOR=0.21, P=0.002, 95% CI, 0.08-0.56). The odds of having anemia in those patients with estimated glomerular filtration rate (eGFR) 60-89 mL/min/1.73 m2 was 6.6 times higher than those with eGFR ≥90 (AOR=6.61, P< 0.001, 95% CI, 2.74-25.93). And those HF patients with eGFR 30-59 mL/min /1.73 m2 had the odds of having anemia 13.5 times as compared to those with eGFR 90 and above (AOR 13.5(3.7-49.4), P <0.001). 10 Conclusion: Anemia is common in outpatient HF patients in our setup. The presence of higher NYHA functional class, lower eGFR and diabetes mellitus were strong predictors of anemia in HF patients. But there was no significant association between age, sex, etiology of HF, use of angiotensin converting enzyme inhibitors /angiotensin receptor blockers (ACEI /ARBs), duration of illness and hospital admission between the anemic and non-anemic patients in this study. Key words: Anemia, Heart failure, prevalence, SPHMMC, Ethiopia