Managing anemia in patients with chronic heart failure: what do we know?

Abstract

Anemia is common in patients with chronic heart failure (HF) with an incidence ranging from 4% to 55% depending on the studied population. Several studies have highlighted that the prevalence of anemia increases with worsening heart failure as reflected by New York Heart Association classification. Additionally, several epidemiological studies have highlighted its role as a prognostic marker, linking it to worse outcomes including; malnutrition, increased hospitalizations, refractory heart failure and death. The pathophysiology of anemia is multifactorial and related to various factors including; hemodilution, iron losses from anti-platelet drugs, activation of the inflammatory cascade, urinary losses of erythropoietin and associated renal insufficiency. There are a host of epidemiological studies examining HF outcomes and anemia, but only a few randomized trials addressing this issue. The purpose of this article is to review the literature that examines the interrelationship of anemia and congestive HF, analyzing its etiology, impact on outcomes and also the role of associated kidney disease as well as cardiorenal syndrome both as a marker of morbidity and mortality.

Anaemia and Long Term Mortality in Heart Failure Patients: A Retrospective Study

“…In our study, anaemia was frequently observed, found in over one-third of HF patients. This is similar to previously observed frequencies [ 1 - 4 ] emphasising that a large part of the patient population with HF has anaemia as a possible factor of co-morbidity.…”

“…Anaemia is common in patients with heart failure (HF) and is found in 4%-55% of the patients [ 1 - 4 ]. Many studies have demonstrated anaemia to be a risk factor in patients with heart failure [ 5 , 6 ] and anaemia is currently targeted in several interventional trials.…”

Assessment of plasma lactate and core‐peripheral temperature gradient in association with stages of naturally occurring myxomatous mitral valve disease in dogs

“…69 HF is known to cause a sustained increase in the concentration of serum proinflammatory cytokines, including IL-1, IL-6, IL-18, and TNF-␣, which can lead to an increase in platelet count. 70,71 The study patients also had normal RBC counts, hemoglobin, or packed cell volumes, thus eliminating anemia as a cause for hyperlactatemia. 43 The limitations of this study include the lack of treatment standardization because the therapeutic approaches had to meet the clinical needs of each patient.…”

Anemia in Heart Failure Patients

“…Furthermore, anemic patients with CHF have more commonly diabetes mellitus and more advance disease, with higher NYHA class and more severe symptoms. Those symptoms include lower exercise capacity, worse quality-of-life scores, greater peripheral edema, lower dry weight and blood pressure, higher use of diuretics and other cardiovascular medications, and worse neurohormonal profile (such as renal dysfunction, high BNP and C-reactive protein, low serum albumin) (range, 30% to 61% versus range, 4% to 23% for less symptomatic ambulatory patients) [ 23 , 24 ]. It is remarkable that anemia does not seem to be related to LV dysfunction, whereas in few studies Hb levels were inversely related to EF.…”

“…Finally, most studies indicate that the prevalence of anemia is increased in patients with CHF who also have co-morbid kidney disease, advanced age, and more severe symptoms when compared to less symptomatic ambulatory populations [ 23 ].…”