Anemia Impacts on Heart Failure Outcomes

Anemia is a common comorbidity in patients with heart failure, affecting approximately one-third of outpatients and up to two-thirds of those with decompensated disease. It arises from multifactorial mechanisms including iron deficiency, chronic inflammation, renal impairment and neurohormonal activation. Clinically, anemia correlates with worse functional status, higher New York Heart Association (NYHA) class and elevated natriuretic peptide levels, and it is associated with increased risks of hospitalisation and all-cause mortality. Although some studies suggest that anemia itself may not be an independent predictor of long-term death when adjusted for markers of disease severity, it remains a valuable indicator of advanced pathology and a potential therapeutic target. In heart failure with preserved ejection fraction (HFpEF), the coexistence of anemia and iron deficiency compounds diastolic dysfunction, reduces exercise capacity and further elevates mortality risk. Correction of iron deficiency, whether anaemic or not, has demonstrated improvements in quality of life and functional capacity, although evidence for hard end points such as survival remains under investigation. Globally, the interplay between anemia, renal dysfunction and congestion underscores the need for integrated management strategies, including routine screening for iron status, renal monitoring and judicious use of intravenous iron and erythropoiesis-stimulating agents. Continued research seeks to clarify whether treatment of anemia can modify long-term outcomes or serves primarily as a marker of severe disease.

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Anemia Impacts on Heart Failure Outcomes publication trend

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Technical terms

Anaemia: A condition defined by reduced haemoglobin concentration in the blood, leading to impaired oxygen delivery.

Heart failure: A syndrome in which the heart cannot pump sufficient blood to meet metabolic demands, resulting in congestion and organ hypoperfusion.

Heart failure with preserved ejection fraction (HFpEF): A form of heart failure characterised by normal or near-normal left ventricular ejection fraction (≥50 %) but impaired diastolic filling.

Brain natriuretic peptide (BNP): A hormone secreted by cardiac ventricles in response to stretch, used as a biomarker of fluid overload and heart failure severity.

Hydration index: A quantitative measure of fluid overload derived from bioimpedance, indicating the extent of congestion.

Transferrin saturation: The ratio of serum iron concentration to total iron-binding capacity, indicating the proportion of iron-binding sites occupied and aiding in the diagnosis of iron deficiency.

References

1. Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role. Biomedicines (2023).
2. Anemia and Iron Deficiency Predict All-Cause Mortality in Patients with Heart Failure and Preserved Ejection Fraction: 6-Year Follow-Up Study. Diagnostics (2024).
3. Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure?. International Journal of Molecular Sciences (2015).
4. Impact of anemia on clinical outcomes in patients with acute heart failure: A systematic review and meta‐analysis. Clinical Cardiology (2024).