Prevalence clinical correlates and outcomes of cardiorenal anemia syndrome among patients with heart failure attended a tertiary hospital in Dodoma, Tanzania: A prospective observational cohort study

Abstract

IntroductionCardiorenal anemia syndrome (CRAS) poses significant complications in heart failure (HF) patients, often leading to unfavourable outcomes but, published data are limited. This study assessed the prevalence, clinical correlates, and outcomes of CRAS among patients with HF who attended the Benjamin Mkapa Hospital (BMH) in Dodoma, Tanzania.Materials and methodsA prospective observational cohort study was carried out at BMH between 18thAugust 2023 and 18thApril 2024. It included patients aged 18 years and above who had been diagnosed with heart failure according to Framingham criteria and confirmed by 2-dimensional transthoracic echocardiography (2D-TTE). The study aimed to investigate the prevalence and clinical associations of cardiorenal anemia syndrome (CRAS) at the beginning of the study, as well as to evaluate CRAS outcomes within a 6-month follow-up period. Continuous data were presented as either mean with standard deviation (SD) or median with interquartile range (IQR), while categorical data were expressed as frequency and proportions. Binary logistic regression, using odds ratios (OR), was utilized to examine clinical associations, while survival rate analysis, employing hazard ratios (HR), was utilized to determine CRAS outcomes. A two-tailed p-value of less than 0.05 was considered statistically significant.ResultsA total of 298 participants were recruited with a mean age of 57±15 years, and 60% were females. In our cohort, CRAS was prevalent in 46.3%. Iron deficiency (OR: 2.5; 95% CI, 1.5-4.1;p= 0.001) and diabetes mellitus (OR 2.1; 95% CI, 1.2-3.4;p= 0.006), were clinically correlated with CRAS, while female sex (OR 0.35; 95% CI, 0.21-0.59;p= 0.000) was inversely clinically correlated with CRAS. Moreover, CRAS was associated with a higher risk of heart failure re-hospitalization compared to those patients with no CRAS (HR: 3.8; 95% CI, 2.4-6.0;p< 0.001).ConclusionIn our setting, CRAS is prevalent among heart failure patients and is linked to higher rates of heart failure-related hospitalizations, leading to increased healthcare utilization and costs. We strongly advocate for multidisciplinary approaches in managing this condition. Nonetheless, further research with robust evidence is necessary to inform policy-making and initiate targeted interventions.