The Anemia Stress Index—Anemia, Transfusions, and Mortality in Patients with Continuous Flow Ventricular Assist Devices

Supriya Shore, Thomas C. Hanff, Jeremy A. Mazurek, Arieh Fox, Monique S. Tanna, Edward W. Grandin, Robert Zhang, Joyce Wald, Carli Peters, Michael A. Acker, Pavan Atluri, J. Eduardo Rame, Lee R. Goldberg, Mariell Jessup, Kenneth B. Margulies, Edo Y. Birati

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


We aimed to identify a simple metric accounting for peri-procedural hemoglobin changes, independent of blood product transfusion strategies, and assess its correlation with outcomes in patients undergoing left ventricular assist device (LVAD) implantation We included consecutive patients undergoing LVAD implantation at a single center between 10/1/2008 and 6/1/2014. The anemia stress index (ASI), defined as the sum of number of packed red blood cells transfused and the hemoglobin changes after LVAD implantation, was calculated for each patient at 24 h, discharge, and 3 months after LVAD implantation. Our cohort included 166 patients (80.1% males, mean age 56.3 ± 15.6 years) followed up for a median of 12.3 months. Increases in ASI per unit were associated with a higher hazard for all-cause mortality and early RV failure. The associations between the ASI and all-cause mortality persisted after multivariable adjustment, irrespective of when it was calculated (adjusted HR of 1.11, 95% CI 1.03–1.20 per unit increase in ASI). Similarly, ASI at 24 h after implant was associated with early RV failure despite multivariable adjustment (OR 1.09, 95% CI 1.05–1.14). We present a novel metric, the ASI, that is correlated with an increased risk for all-cause mortality and early RV failure in LVAD recipients.

Original languageEnglish
Article number4517
JournalJournal of Clinical Medicine
Issue number15
StatePublished - 3 Aug 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors.


E.Y.B.—Research support paid to the University of Pennsylvania—Medtronic Inc. and Impulse Dynamics. S.S. is supported by American Heart Association Career Development Award (ID 855105). The other authors declare no conflict of interest.

FundersFunder number
American Heart Association855105


    • left ventricular assist device
    • outcomes


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