Chronic heart failure (CHF) patients with anemia are more likely to face adverse outcomes than those without anemia, according to a recent meta-analysis.

Physicians at Charles Sturt University in Wagga Wagga, Australia, analyzed 21 trials that involved a total of 97,699 patients. The prevalence of anemia ranged from 10%-58% (Congest Heart Fail. 2009;15:123-130).

The researchers found a close correlation between the severity of anemia, as evidenced by lower baseline hemoglobin (Hb) concentrations, and higher scores on the New York Heart Association (NYHA) functional classification. For example, NYHA class III-IV included more patients with anemia than without (risk ratio [RR] 1.35). Similarly, patients rated as NYHA class I-II were less like- ly to be anemic than those in NYHA class III-IV (RR 0.80). Hb levels were also closely related to mortality (RR 1.66).

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All patients made similar use of ACE inhibitors, digitalis, diuretics, beta blockers, aspirin, and statins. Anemic patients tended, however, to be older and to have renal deficiency, lower BMI, lower systolic BP, and lower plasma levels of sodium. The etiology of their CHF was more likely to be diabetes or ischemic heart disease.

“The majority of these studies suggested that all-cause mortality or hospitalization rates in anemia patients were higher than in nonanemia patients, and anemia was an independent predictor of both,” the authors conclude.