Association of Admission Anemia Severity With Frailty and Hospitalization-Associated Disability at Discharge and 1-Year Mortality After Discharge in Patients With Heart Failure ― A Multicenter Cohort Analysis of the J-Proof HF Registry ―

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Background: Anemia and functional decline are common in older patients hospitalized for heart failure. We examined whether anemia severity at admission was associated with frailty at discharge, hospitalization-associated disability (HAD), and 1-year mortality after discharge. Methods and Results: This multicenter analysis of the J-Proof HF registry included 8,691 patients aged ≥65 years, classified as non-anemia, anemia, or severe anemia (hemoglobin <10 g/dL). Frailty was defined using the Japanese Cardiovascular Health Study criteria (≥3), and HAD as a ≥5-point decline in the Barthel Index from pre-admission to discharge. Multivariable logistic regression and Cox models were used. Higher anemia severity was independently associated with frailty at discharge in both the primary and fully expanded models (fully expanded model: odds ratio 1.18; 95% confidence interval 1.10-1.27). The association with HAD was significant in the primary model but was attenuated after adjustment for serum albumin and was no longer statistically significant in the fully expanded model. Anemia and severe anemia were associated with higher 1-year mortality after adjustment for frailty and HAD, but these associations were also attenuated and no longer significant in the fully expanded model. Conclusions: Admission anemia severity was consistently associated with frailty at discharge, whereas associations with HAD and 1-year mortality were attenuated after expanded adjustment. Admission hemoglobin may serve as an early marker of functional vulnerability and broader clinical complexity.

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