SPC365

High prevalence of polycythemia in heart failure patients

Session: Posters (Sessão 5 - Écran 4) - Insuficiência Cardíaca 5 - Marcadores Serológicos
Speaker: Joana Silva Ferreira

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Joana Silva Ferreira; Sara Gonçalves; José Maria Farinha; Ana Esteves; António Pinheiro; Rui Coelho; Rui Caria

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Secondary polycythemia is associated with states of oxygen rarefaction&nbsp;such as altitude and lung disease. Heart failure (HF), similarly to lung disease, can be associated with periods of hypoxemia. However, the prevalence of polycythemia in HF patients has not yet been reported.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: to assess the prevalence of polycythemia in patients hospitalized for heart failure, whether it persists after hospital discharge and&nbsp;potential risk factors for this anomaly.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We conducted an observational study including all consecutive patients (with no exclusion criteria) admitted in the Cardiology ward for HF between August 2018 and November 2021, which we compared with a control group of non-HF hospital admissions.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Polycythemia was defined, according to the World Health Organization criteria, as hematocrit (Htc) &gt; 49% or hemoglobin (Hb) &gt; 16.5 g/dL in males and Htc &gt; 48% or Hb &gt; 16 g/dL in females.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients (pts) who presented Hb or Htc values compatible with polycythemia in&nbsp;more than one assessment were then divided into two groups &ndash; &ldquo;persistent polycythemia (PP)&rdquo; and &ldquo;transitory polycythemia&rdquo; &ndash; according to whether the elevated Htc/Hb persisted or resolved after hospital&nbsp;discharge, respectively.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We studied 101 pts admitted for HF (70% male with a median age of 68 years) with a median ejection fraction (EF) of 30%. 10% of patients in the HF group had chronic obstructive pulmonary disease and 13% had sleep apnea.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The control group consisted of 101 pts, mostly&nbsp;admitted for acute coronary syndrome (67%) and dysrhythmias (20%).&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Apart from the higher prevalence of non-preserved ejection fraction in the HF group (78% vs 26%, p&lt;0.001) and the higher prevalence of dyslipidemia in the non-HF group (62% vs 45%, p=0.014), there were no other significant differences in demographics and comorbidities between two groups.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The prevalence of polycythemia in pts hospitalized for HF&nbsp;was 21%, from which approximately half persisted after discharge, a prevalence much higher to the one observed in the control group (10% vs 2%, p=0.007). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Within the HF group, pts with PP were younger and were more often smokers. Prevalence of COPD and sleep apnea did not significantly differ. On multivariate analysis, age was the only independent predictor of PP.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: This study reports a 10% prevalence of persistent polycythemia in patients with HF. <span style="color:black">To our knowledge, this is the first study to report this high prevalence of polycythemia in HF patients</span>, which is much higher than the one observed in non-HF patients and comparable with its reported prevalence in COPD patients. We speculate that a response to chronic or repeated episodes of hypoxemia might promote erythropoietin (EPO) production and consequently result in a secondary polycythemia. Further studies with a larger sample (and dosing of EPO) are necessary to confirm this prevalence and establish the prognostic implications of PP.</span></span></p>