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Reduced red Blood Counts in older Heart failure participants: 

Evaluation And Related Treatment (RBC HEART) study 

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Leadership:

Alan Go, MD, Investigator  Kaiser Permanente Northern California
David H. Smith, PhD, Investigator Kaiser Permanente Northwest
Jerry H. Gurwitz, MD, Investigator Meyers Primary Care Institute
Kristi Reynolds, PhD, MPH, Investigator Kaiser Permanente Southern California


Study Summary

The Reduced red Blood Counts in older Heart failure participants: Evaluation And Related Treatment (RBC HEART) dataset was composed to establish and characterize a contemporary cohort of adults with heart failure and anemia within large, diverse, community-based populations in order to provide critical insight into outcome event rates, practice patterns, and potential health disparities. The RBC HEART dataset is comprised of patients with heart failure and anemia and has been used to address research questions related to epidemiology, management and outcomes of patients with heart failure and anemia. The five participating sites (Kaiser Permanente Northern California, Kaiser Permanente Southern California, Kaiser Permanente Northwest, Kaiser Permanente Colorado, and Fallon Community Health Plan) followed the same data collection steps. The final dataset was compiled at KPNC to produce an analytic dataset with a single, common structure. 

Population

The RBC HEART dataset is comprised of patients with diagnosed heart failure (HF) between January 1, 2008 and December 31, 2012 with at least one year of follow up except due to death through December, 31, 2013. Diagnosed HF is defined as:

  • = 1 primary discharge diagnosis of HF, or
  • = 3 ambulatory visits coded for HF with at least one visit being to a cardiologist during the study period.

Patients were further characterized for anemia status at baseline and during follow-up. Anemia was defined using World Health Organization (WHO) standards:

  • Hemoglobin < 12.0 g/dL for women.
  • Hemoglobin < 13.0 g/dL for men.

The anemia cohort was further stratified by prevalent and incident anemia. Prevalent anemia is defined as having documented anemia prior to HF diagnosis date. Incident anemia is defined as having no prior known anemia and documented anemia during follow-up. The RBC HEART dataset has been used to evaluate practice patterns in the frequency, timing and extent of evaluation for reversible causes of anemia in contemporary clinical practice. The dataset consists of patient data from five participating sites: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Southern California (KPSC), Kaiser Permanente Colorado (KPCO), Kaiser Permanente Northwest (KPNW), Fallon Community Health Plan (FCHP). 

Table 1. RBC HEART Dataset Member Counts by Site

Site Number of Members Percent of Dataset
Kaiser Permanente Northern California37,15741.5%
Kaiser Permanente Southern California37,514
41.9%
Kaiser Permanente Colorado
5,8216.5%
Kaiser Permanente Northwest5,5306.2%
Fallon Community Health Plan3,4563.9%
Total 89,478 100.0%

Cohort Characteristics 

The mean age was 74 years old at HF diagnosis date. 47% of the overall cohort were women. 41% of the overall cohort had diagnosed anemia at baseline. 31.7% of the cohort had incident anemia during the follow-up period. Overall 73.5% of the overall cohort had diagnosed anemia by the end of the follow-up period.

Figure 1. RBC HEART Study Sub cohorts




Figure 2. RBC HEART Study Dataset Age Distribution



Data Source

All member data was extracted using the Virtual Data Warehouse (VDW). The VDW is a standardized resource comprised of: (1) computerized datasets stored behind separate security firewalls, including variables with identical names, formats, and specifications; (2) informatics tools that facilitate storage, retrieval, processing, and managing the datasets; and (3) detailed data documentation. All data are linked by a unique identifier so that data elements can be rolled up to the individual person-level. We used the VDW to characterize each sites cohort of patients with regard to relevant exposure and outcome variables.

Key Publications

Ambrosy AP, Gurwitz JH, Tabada GH, Artz A, Schrier S, Rao SV, Barnhart HX, Reynolds K, Smith DH, Peterson PN, Sung SH, Cohen HJ, Go AS. Incident Anemia in Older Adults with Heart Failure Rate, Etiology, and Association with Outcomes. Eur Heart J Qual Care Clin Outcomes. 2019 Mar 7. pii: qcz010. doi:10.1093/ehjqcco/qcz010. PubMed PMID: 30847487.


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