Skip to main content

Advertisement

SpringerLink
Log in

The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

This review article summarizes the current medical literature reporting on the prevalence and prognostic significance of anemia in patients with heart failure. Almost all currently available data indicate that anemia is common in heart failure populations, with the majority of studies indicating prevalence >20%. Anemia appears to be more highly prevalent in patients with advanced age, with more severe limitations in functional capacity, and with greater severity of co-morbid chronic kidney disease. In most reported studies anemia is an independent predictor of increased mortality risk and increased risk of hospitalization for heart failure. These data provide the rationale for interventional treatment trials to determine if anemia is in the causal pathway for disease progression and increased mortality risk in HF patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Silverberg DS, Wexler D, Blum M et al (2000) The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 35(7):1737–1744

    Article  PubMed  CAS  Google Scholar 

  2. Tanner H, Moschovitis G, Kuster GM et al (2002) The prevalence of anemia in chronic heart failure. Int J Cardiol 86(1):115–121

    Article  PubMed  Google Scholar 

  3. Kalra PR, Bolger AP, Francis DP et al (2003) Effect of anemia on exercise tolerance in chronic heart failure in men. Am J Cardiol 91(7):888–891

    Article  PubMed  Google Scholar 

  4. Brucks S, Little WC, Chao T et al (2004) Relation of anemia to diastolic heart failure and the effect on outcome. Am J Cardiol 93(8):1055–1057

    Article  PubMed  Google Scholar 

  5. Ezekowitz JA, McAlister FA, Armstrong PW (2005) The interaction among sex, hemoglobin and outcomes in a specialty heart failure clinic. Can J Cardiol 21(2):165–171

    PubMed  Google Scholar 

  6. Maggioni AP, Opasich C, Anand I et al (2005) Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail 11(2):91–98

    Article  PubMed  Google Scholar 

  7. Colin-Ramirez E, Castillo-Martinez L, Orea-Tejeda A et al (2006) Body composition and echocardiographic abnormalities associated to anemia and volume overload in heart failure patients. Clin Nutr 25(5):746–757

    Article  PubMed  Google Scholar 

  8. Go AS, Yang J, Ackerson LM et al (2006) Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation 113(23):2713–2723

    Article  PubMed  CAS  Google Scholar 

  9. de Silva R, Rigby AS, Witte KK et al (2006) Anemia, renal dysfunction, and their interaction in patients with chronic heart failure. Am J Cardiol 98(3):391–398

    Article  PubMed  Google Scholar 

  10. Westenbrink BD, Visser FW, Voors AA et al (2007) Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J 28(2):166–171

    Article  PubMed  CAS  Google Scholar 

  11. Inglis SC, Stewart S, Papachan A et al (2007) Anaemia and renal function in heart failure due to idiopathic dilated cardiomyopathy. Eur J Heart Fail 9(4):384–390

    Article  PubMed  CAS  Google Scholar 

  12. Cromie N, Lee C, Struthers AD (2002) Anaemia in chronic heart failure: what is its frequency in the UK and its underlying causes? Heart 87(4):377–378

    Article  PubMed  CAS  Google Scholar 

  13. McClellan WM, Flanders WD, Langston RD et al (2002) Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol 13(7):1928–1936

    Article  PubMed  Google Scholar 

  14. Horwich TB, Fonarow GC, Hamilton MA et al (2002) Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 39(11):1780–1786

    Article  PubMed  Google Scholar 

  15. Szachniewicz J, Petruk-Kowalczyk J, Majda J et al (2003) Anaemia is an independent predictor of poor outcome in patients with chronic heart failure. Int J Cardiol 90(2–3):303–308

    Article  PubMed  CAS  Google Scholar 

  16. Androne AS, Katz SD, Lund L et al (2003) Hemodilution is common in patients with advanced heart failure. Circulation 107(2):226–229

    Article  PubMed  Google Scholar 

  17. Ezekowitz JA, McAlister FA, Armstrong PW (2003) Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation 107(2):223–225

    Article  PubMed  Google Scholar 

  18. Kosiborod M, Smith GL, Radford MJ et al (2003) The prognostic importance of anemia in patients with heart failure. Am J Med 114(2):112–119

    Article  PubMed  Google Scholar 

  19. Nordyke RJ, Kim JJ, Goldberg GA et al (2004) Impact of anemia on hospitalization time, charges, and mortality in patients with heart failure. Value Health 7(4):464–471

    Article  PubMed  Google Scholar 

  20. Wexler D, Silverberg D, Sheps D et al (2004) Prevalence of anemia in patients admitted to hospital with a primary diagnosis of congestive heart failure. Int J Cardiol 96(1):79–87

    Article  PubMed  Google Scholar 

  21. Kosiborod M, Curtis JP, Wang Y et al (2005) Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med 165(19):2237–2244

    Article  PubMed  Google Scholar 

  22. Ceresa M, Capomolla S, Pinna G et al (2005) Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers. Monaldi Arch Chest Dis 64(2):124–133

    PubMed  Google Scholar 

  23. Gardner RS, Chong KS, Morton JJ et al (2005) N-terminal brain natriuretic peptide, but not anemia, is a powerful predictor of mortality in advanced heart failure. J Card Fail 11(5 Suppl):S47–53

    Article  PubMed  CAS  Google Scholar 

  24. Maraldi C, Volpato S, Cesari M et al (2006) Anemia, physical disability, and survival in older patients with heart failure. J Card Fail 12(7):533–539

    Article  PubMed  Google Scholar 

  25. Newton JD, Squire IB (2006) Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure. Heart 92(10):1441–1446

    Article  PubMed  CAS  Google Scholar 

  26. Sanchez-Torrijos J, Gudin-Uriel M, Nadal-Barange M et al (2006) Prognostic value of discharge hemoglobin level in patients hospitalized for acute heart failure. Rev Esp Cardiol 59(12):1276–1282

    Article  PubMed  Google Scholar 

  27. Grigorian Shamagian L, Varela Roman A, Garcia-Acuna JM et al (2006) Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function. Heart 92(6):780–784

    Article  PubMed  CAS  Google Scholar 

  28. Berry C, Norrie J, Hogg K et al (2006) The prevalence, nature, and importance of hematologic abnormalities in heart failure. Am Heart J 151(6):1313–1321

    Article  PubMed  Google Scholar 

  29. Varadarajan P, Gandhi S, Sharma S et al (2006) Prognostic significance of hemoglobin level in patients with congestive heart failure and normal ejection fraction. Clin Cardiol 29(10):444–449

    Article  PubMed  Google Scholar 

  30. Silva RP, Barbosa PH, Kimura OS et al (2007) Prevalence of anemia and its association with cardio-renal syndrome. Int J Cardiol 120(2):232–236

    Article  PubMed  Google Scholar 

  31. Baggish AL, van Kimmenade R, Bayes-Genis A et al (2007) Hemoglobin and N-terminal pro-brain natriuretic peptide: independent and synergistic predictors of mortality in patients with acute heart failure results from the International Collaborative of NT-proBNP (ICON) study. Clin Chim Acta 381(2):145–150

    Article  PubMed  CAS  Google Scholar 

  32. Al-Ahmad A, Rand WM, Manjunath G et al (2001) Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 38(4):955–962

    Article  PubMed  CAS  Google Scholar 

  33. Mozaffarian D, Nye R, Levy WC (2003) Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol 41(11):1933–1939

    Article  PubMed  Google Scholar 

  34. Felker GM, Gattis WA, Leimberger JD et al (2003) Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure. Am J Cardiol 92(5):625–628

    Article  PubMed  Google Scholar 

  35. Kalra PR, Collier T, Cowie MR et al (2003) Haemoglobin concentration and prognosis in new cases of heart failure. Lancet 362(9379):211–212

    Article  PubMed  CAS  Google Scholar 

  36. Sharma R, Francis DP, Pitt B et al (2004) Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J 25(12):1021–1028

    Article  PubMed  CAS  Google Scholar 

  37. Anand I, McMurray JJ, Whitmore J et al (2004) Anemia and its relationship to clinical outcome in heart failure. Circulation 110(2):149–154

    Article  PubMed  Google Scholar 

  38. Anand IS (2005) Pathogenesis of anemia in cardiorenal disease. Rev Cardiovasc Med 6(Suppl 3):S13–21

    PubMed  Google Scholar 

  39. Ishani A, Weinhandl E, Zhao Z et al (2005) Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 45(3):391–399

    Article  PubMed  CAS  Google Scholar 

  40. O’Meara E, Clayton T, McEntegart MB et al (2006) Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation 113(7):986–994

    Article  PubMed  Google Scholar 

  41. Komajda M, Anker SD, Charlesworth A et al (2006) The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 27(12):1440–1446

    Article  PubMed  Google Scholar 

  42. Valeur N, Nielsen OW, McMurray JJ et al (2006) Anaemia is an independent predictor of mortality in patients with left ventricular systolic dysfunction following acute myocardial infarction. Eur J Heart Fail 8(6):577–584

    Article  PubMed  Google Scholar 

  43. Izaks GJ, Westendorp RG, Knook DL (1999) The definition of anemia in older persons. JAMA 281(18):1714–1717

    Article  PubMed  CAS  Google Scholar 

  44. IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000 (2001). Am J Kidney Dis 37(1 Suppl 1):S182–238

    Google Scholar 

  45. Beutler E, Waalen J (2006) The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 107(5):1747–1750

    Article  PubMed  CAS  Google Scholar 

  46. Gagnon DR, Zhang TJ, Brand FN et al (1994) Hematocrit and the risk of cardiovascular disease–the Framingham study: a 34-year follow-up. Am Heart J 127(3):674–682

    Article  PubMed  CAS  Google Scholar 

  47. Brown DW, Giles WH, Croft JB (2001) Hematocrit and the risk of coronary heart disease mortality. Am Heart J 142(4):657–663

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, 06510, USA

    Yi-Da Tang & Stuart D. Katz

  2. Yale Heart Failure and Transplant Center, Yale University School of Medicine, 135 College St. Suite 301, New Haven, CT, 06510, USA

    Yi-Da Tang & Stuart D. Katz

Authors
  1. Yi-Da Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stuart D. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stuart D. Katz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tang, YD., Katz, S.D. The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes. Heart Fail Rev 13, 387–392 (2008). https://doi.org/10.1007/s10741-008-9089-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-008-9089-7

Keywords

Search

Navigation