Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum.

This study aims to establish a reliable prevalence estimate of anaemia in patients with different severities of heart failure (HF), and to identify whether the severity of HF and anaemia predicts either mortality or hospitalization from HF. While data from previous studies has established an association between anaemia and HF, recent European updates to HF classification prompted this study and the question of whether there may be a differential effect of anemia based on HF severity.

A total of 42 895 patients from a large registry of HF patients in Sweden were included. Patients were stratified according to the ejection fraction, with 23% having HFrEF (EF <40%), 21% with HFmrEF (EF 40-49%) and 55% with HFpEF (EF ≥50%).

There was a higher prevalence of anaemia in the HFpEF group (41%) than the HFmrEF group (35%) or the HFrEF group (32%). Additionally, while anaemia was independently associated with mortality and increased hospitalization across all HF groups, there was a higher risk of mortality or hospitalization in the HFpEF (OR 1.24, P < 0.001) and HFmrEF (OR 1.26, P < 0.001) groups compared to patients with HFrEF (OR 1.14, P < 0.001).

While the authors are careful to note the limitations of this observational study, their sample size is a real strength and this study should prompt awareness of anaemia and its adverse consequences in HF patients that have been generally considered less sick.

– Micah T. Prochaska (SABM reviewer)