Earlier blood transfusion may reduce heart failure, arrhythmia in adults with heart disease – www.heart.org

Report on Post-Surgical Blood Transfusion Strategies and Alignment with Sustainable Development Goals

Executive Summary

A study presented at the American Heart Association’s Scientific Sessions 2025, the Transfusion Trigger after Operations in High Cardiac Risk Patients (TOP) trial, investigated optimal blood transfusion timing for heart disease patients post-surgery. The findings indicate that an earlier, more liberal transfusion strategy does not reduce severe complications but may lower the risk of secondary heart issues. This report analyzes these findings through the lens of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 12 (Responsible Consumption and Production), and SDG 10 (Reduced Inequalities).

Key Research Findings: The TOP Trial

The trial compared two transfusion strategies for high-risk cardiac patients following major surgery:

• Liberal (Early) Strategy: Transfusion when hemoglobin levels dropped below 10 g/dL.
• Restrictive (Later) Strategy: Transfusion when hemoglobin levels dropped below 7 g/dL.

The primary outcomes measured at 90 days post-surgery revealed:

1. No Significant Difference in Severe Complications: The combined rate of death, heart attack, kidney failure, stroke, or need for a heart procedure was similar between the groups (9.1% in the liberal group vs. 10.1% in the restrictive group).
2. Reduced Risk of Secondary Heart Complications: The liberal transfusion strategy was associated with a 41% lower risk of developing irregular heart rhythms and heart failure (5.9% in the liberal group vs. 9.9% in the restrictive group).

Implications for SDG 3: Good Health and Well-being

This research directly contributes to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. By refining clinical practices, the study supports several key targets:

• Target 3.4: Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment. The study seeks to optimize post-operative care for patients with cardiovascular disease, a leading non-communicable disease, thereby preventing complications and improving health outcomes.
• Target 3.8: Achieve universal health coverage, including access to quality essential health-care services. The trial generates critical evidence to inform clinical guidelines, ensuring that blood transfusion, a vital healthcare service, is administered in a way that maximizes patient safety and benefit.

Contributions to SDG 12: Responsible Consumption and Production

The study provides crucial data for SDG 12, which promotes sustainable consumption patterns. Donated blood is a finite and critical resource, and its management is a global health concern.

• Target 12.2: Achieve the sustainable management and efficient use of natural resources. The debate between liberal and restrictive transfusion strategies is central to the responsible use of blood supplies. While a restrictive approach conserves this resource, the TOP trial suggests that for high-risk cardiac patients, a more liberal use may prevent other costly and debilitating complications.
• Informed Decision-Making: These findings help healthcare systems develop nuanced, evidence-based policies that balance the conservation of blood products with the specific clinical needs of high-risk patient populations, ensuring resources are used most effectively to promote health.

Addressing SDG 10: Reduced Inequalities

While advancing medical knowledge, the study’s demographic limitations highlight challenges related to SDG 10, which calls for reducing inequality within and among countries.

• Study Population: The trial participants were 98% male, with an average age of 70. This limits the generalizability of the findings to women and other age groups.
• A Call for Inclusive Research: This limitation underscores the urgent need for future research to include diverse populations. To ensure that medical advancements benefit all and do not perpetuate health disparities, clinical trials must be designed to reflect the broader patient population, a key step in reducing health inequalities.

Study Limitations and Future Directions

The report acknowledges the following limitations as identified in the study:

• The participant base consisted primarily of older men, potentially limiting the applicability of the results to women.
• The study was not blinded, which may have influenced patient care decisions.
• The number of severe complications was lower than anticipated, which may have prevented the detection of smaller differences between the strategies.

Further research is required to confirm the findings regarding secondary heart complications and to evaluate these strategies in more diverse patient populations to fully align with the goals of equitable health outcomes.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is dedicated to a medical research study (the TOP trial) aimed at improving health outcomes for a specific patient group. It focuses on the health and well-being of individuals with heart disease undergoing major surgery. The research investigates the best clinical practices for blood transfusions to prevent severe complications, directly contributing to the goal of ensuring healthy lives and promoting well-being for all at all ages. The study’s objective is to determine a safer and more effective treatment strategy, which is a core component of SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article directly addresses this target by focusing on improving the treatment of patients with heart disease, which is a major non-communicable disease (NCD). The research compares two treatment strategies for blood transfusions to reduce the risk of complications and mortality following surgery. The study explicitly measures outcomes such as “death, heart attack, kidney failure, need for a heart procedure or stroke,” all of which are related to managing and treating NCDs to prevent premature mortality and morbidity.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.4
   • The article provides specific, measurable indicators used in the TOP trial to assess the effectiveness of the different transfusion strategies. These can be seen as direct measures of progress in treating cardiovascular disease. The indicators mentioned are:
     • Mortality Rate: The study measured “death” as a primary component of its severe complication analysis.
     • Morbidity from Cardiovascular Disease: The research quantified the incidence of several severe complications. The article states, “Severe complication rates — death, heart attack, kidney failure, need for a heart procedure or stroke — were similar among patients who received earlier or later blood transfusion: 9.1% in the early (liberal) transfusion group vs. 10.1% in the later (restrictive) transfusion group.”
     • Incidence of Specific Heart Conditions: The study also measured less severe but serious complications, providing precise data. The article notes, “Irregular heart rhythms and heart failure occurred in 5.9% of patients in the early (liberal) transfusion group compared to 9.9% in the later (restrictive) transfusion group.” These percentages serve as direct indicators of treatment outcomes.

4. Summary Table of SDGs, Targets, and Indicators

Source: newsroom.heart.org