Transfusion Strategies Show No QOL Improvement in Anemia Patients

A recent secondary analysis of data from the Myocardial Ischemia and Transfusion (MINT) trial has found no difference in quality of life (QOL) outcomes between liberal versus restrictive transfusion strategies in patients with myocardial infarction (MI) and anemia.1

Thanks to advances in acute MI therapies, the numbers of surviving patients with chronic coronary artery disease and impaired left ventricular function are rising. However, these patients are at a heightened risk for nonfatal and fatal cardiac events. Previous studies have indicated a generalized focus on secondary preventative efforts and attenuation of risk of consequences of the infarct. Equally important, though largely understudied, are health-related QOL changes emerging in survivors of MI.2

A few existing studies have examined transfusion and suggested that they may improve QOL, but the evidence is insufficient to make conclusive decisions. Past trials have been relatively small, sometimes overlooking important subgroups and therefore unable to detect meaningful treatment effects of transfusion on QOL. Notably, no trials have been conducted in patients with MI and anemia, leaving the effectiveness of transfusion in QOL in this subset unknown.1

“To address this question, we analyzed data from the Myocardial Ischemia and Transfusion (MINT) trial,” wrote Micah T. Prochaska, MD, MSc, department of medicine, University of Chicago, and colleagues. “The aim of this prespecified secondary analysis was to determine if a liberal transfusion strategy compared with a restrictive transfusion strategy affected 30-day postrandomization QOL.”1

The MINT trial, conducted from 2017-2023, collected and randomized 3504 patients with acute MI and anemia from across 6 countries. Patients were randomly assigned to a restrictive strategy—where RBCs were transfused at a hemoglobin (Hb) threshold of 7-8 g/dL—or to a liberal strategy—where RBCs were transfused at an Hb threshold of 10 g/dL throughout hospitalization. The primary outcome was death or MI at 30 days. The prespecified secondary outcome was health-related QOL.1

Of the patients included in MINT, QOL data was available for 2525 (72%). An additional 319 patients (9.1%) died before the 30-day follow-up and were included in the utility index score QOL analyses (2844 [81.1%]). Strong positive correlations were noted between the activity, mobility, and self-care QOL domains, and each had negative correlations with the utility index score. All other QOL domains had moderate to weak correlations.1

No statistically significant differences were observed in the median or mean levels of any QOL domain (usual activities, anxiety/depression, pain/discomfort, mobility, or self-care) between the restrictive of liberal transfusion arm 30 days after randomization. A higher percentage of patients in the liberal group reported no problems compared to the restrictive group in usual activities (506 of 1268 [39.9%] versus 473 of 1247 [37.9%]), mobility (474 of 1270 [37.3%] versus 460 of 1254 [36.7%]), and self-care domains (858 of 1271 [67.5%] versus 803 of 1254 [64%]). However, none of these differences were statistically significant.1

Although the analysis demonstrated no difference in health-related QOL 30 days after randomization, Prochaska and colleagues still noted the trial as an important step in trying to understand how RBC transfusion affects QOL. Additionally, the sample size from the MINT trial was large enough to be comprehensive in detecting statistically and clinically significant effects of transfusion on QOL.1

“As a result, confidence in the finding from the primary analysis that transfusion does not affect overall QOL in the population at 30 days should be high,” Prochaska wrote. “The results also have significant practice implications and suggest that the transfusion strategy during hospitalization for patients with acute MI and anemia does not influence postdischarge QOL as an important clinical outcome.”1

References

1. Prochaska MT, Portela GT, Brooks MM, et al. Transfusion Strategy Effect on Quality of Life in Patients With Myocardial Infarction and Anemia: A Secondary Analysis of the MINT Randomized Clinical Trial. JAMA Intern Med. Published online June 03, 2025. doi:10.1001/jamainternmed.2025.0654

2. Lewis EF, Li Y, Pfeffer MA, et al. Impact of cardiovascular events on change in quality of life and utilities in patients after myocardial infarction: a VALIANT study (valsartan in acute myocardial infarction). JACC Heart Fail. 2014;2(2):159-165. doi:10.1016/j.jchf.2013.12.003