Speakers - 2026

Title: Association Between Admission Hemoglobin Levels and In-Hospital Outcomes in Patients Presenting with Acute Decompensated Heart Failure

Abstract

Background: Anemia is frequently observed in patients hospitalized with acute decompensated heart failure (ADHF) and may contribute to adverse clinical outcomes through impaired oxygen delivery and worsening myocardial stress. While chronic anemia has been associated with long-term mortality in heart failure populations, the relationship between admission hemoglobin levels and short-term in-hospital outcomes remains incompletely characterized in contemporary hospitalized cohorts.

Methods: We conducted a retrospective cohort study of adult patients admitted with a primary diagnosis of ADHF between January 2020 and December 2024 across multiple tertiary-care centers within a federated research network. Patients were stratified according to admission hemoglobin levels into anemic and non-anemic groups based on World Health Organization criteria. Primary outcomes included in-hospital mortality and intensive care unit (ICU) admission. Secondary outcomes included cardiogenic shock, acute kidney injury (AKI), need for mechanical ventilation, and hospital length of stay. Multivariable logistic regression analyses were performed to adjust for baseline demographic and clinical characteristics including age, sex, diabetes mellitus, hypertension, chronic kidney disease, atrial fibrillation, and ischemic heart disease.

Results: A total of 48,732 patients hospitalized with ADHF were included in the analysis, of whom 21,406 (43.9%) met criteria for anemia on admission. Patients with anemia were older and had a higher burden of cardiovascular comorbidities. In-hospital mortality occurred more frequently in the anemic cohort compared with non-anemic patients (4.8% vs 2.9%, p<0.001). ICU admission rates were similarly higher among anemic patients (18.6% vs 12.4%, p<0.001). After multivariable adjustment, admission anemia remained independently associated with increased odds of in-hospital mortality (aOR 1.41, 95% CI 1.29–1.55, p<0.001), ICU admission (aOR 1.32, 95% CI 1.25–1.39, p<0.001), AKI (aOR 1.27, 95% CI 1.20–1.34, p<0.001), and mechanical ventilation (aOR 1.18, 95% CI 1.08–1.29, p<0.001). Median hospital length of stay was also significantly longer in anemic patients (6 vs 4 days, p<0.001).

Conclusions: Admission anemia is independently associated with worse in-hospital outcomes among patients presenting with acute decompensated heart failure. Early recognition of anemia may assist with risk stratification and identification of high-risk patients requiring closer monitoring during hospitalization. Further studies are warranted to determine whether targeted correction of anemia may improve short-term outcomes in this population.