The prevalence and natural history of anaemia in an optimally treated heart failure population

The prevalence of anaemia in heart failure (HF) is becoming better recognised, yet little is known about its natural history in a HF population.
We examined the records of 200 consecutive patients who were admitted to our service with New York Heart Association (NYHA) class IV HF, survived and were followed for six months following discharge. Complete records were available on 120 patients. Anaemia was defined as a haemoglobin concentration of < 13 g/dL in males and < 12 g/dL in females. Forty-one patients (34%) were found to have anaemia of unknown cause on admission. At follow-up (mean time 6.1+0.3 months), 28 patients were persistently anaemic. The haemoglobin concentration in the remaining 13 had returned to normal. A further group of 11 patients had become anaemic during the six-month follow-up period. All patients had been treated with maximally tolerated medical therapy. Anaemia was found to be equally prevalent in patients with preserved systolic function HF. Factors found to be independently associated with lower haemoglobin at follow-up were female sex, a history of gastrointestinal disease, inflammatory disease and a low glomerular filtration rate (GFR). Haemoglobin concentration at follow-up was found, on univariate analysis, to be associated with an increased risk of a HF-related admission during the follow-up period and increased severity of HF symptoms. On multivariate analysis, haemoglobin concentration at follow-up was found to be an independent predictor of NYHA class III–IV symptoms. In conclusion, anaemia is prevalent in a population admitted with class IV failure. While the haemoglobin concentration had normalised in a significant number of patients during follow-up, the presence of anaemia six months after discharge was associated with having a HF-related readmission and independently associated with moderate-to-severe HF symptoms.