Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE)

J Am Coll Cardiol. 2003 Jun 4;41(11):1933-9. doi: 10.1016/s0735-1097(03)00425-x.


Objectives: Our aim was to examine the relationships between serum hematocrit (Hct) and risk of all-cause mortality among patients with severe heart failure (HF).

Background: Anemia occurs with increased frequency in severe HF. However, few studies have examined the impact of anemia on mortality in this population.

Methods: Using a prospective cohort design, we evaluated the relationships between baseline serum Hct and mortality among 1,130 patients with left ventricular EF <30% and New York Heart Association functional class IIIB or IV HF treated with angiotensin-converting enzyme inhibitors, diuretics, and digitalis. Mortality was ascertained by centralized adjudication.

Results: The mean Hct was 41.8% (range 25.4% to 58.8%). Over 15 months of mean follow-up, there were 407 deaths (29 per 100 person-years). After adjustment for potential confounders, those in the lowest quintile of Hct (range 25.4% to 37.5%) had a 52% higher risk of death (hazard ratio 1.52, 95% confidence interval 1.11 to 2.10), compared with the highest quintile (range 46.1% to 58.8%). Within the lowest quintile of Hct, each 1% decrease in Hct was associated with an 11% higher risk of death (p < 0.01), whereas within the four higher quintiles of Hct, Hct was not associated with total mortality. Evaluation of different causes of death indicated that a lower Hct was strongly associated with death from progressive HF, rather than sudden death or other deaths.

Conclusions: Among patients with severe HF, anemia is a significant independent risk factor for death, with a progressively higher risk with increasing severity of anemia. Further investigation of the etiologies, prevention, and treatment of anemia in severe HF is warranted.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Amlodipine / therapeutic use*
  • Anemia / blood
  • Anemia / drug therapy*
  • Anemia / mortality*
  • Calcium Channel Blockers / therapeutic use*
  • Cause of Death
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Failure / blood
  • Heart Failure / drug therapy*
  • Heart Failure / mortality*
  • Hematocrit
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Stroke Volume / physiology
  • Survival Analysis
  • Treatment Outcome


  • Calcium Channel Blockers
  • Amlodipine