Anemia has been recognized as a risk as well as a precipitating factor in ischemic heart disease, and in congestive heart failure (CHF). However, there are still open questions regarding the prevalence of anemia in CHF, and the severity and associated clinical manifestations of the anemic CHF patient. In order to characterize CHF in Israel, a national survey was conducted during the period March 1–April 30, 2004. Data were collected on all patients with CHF exacerbation admitted to 96 departments of medicine and 26 cardiology units throughout the country. In this study we have focused on anemia in CHF patients with a special emphasis on the differences observed between CHF patients with anemia (A group) and CHF patients with no anemia (NA group).

Results: Of 2388 patients admitted for exacerbation of CHF, 1326 (55.5%) were found to have anemia (<13g/dl for men, <12g/dl women). Both A and NA groups had similar male/female ratio (57.2%/42.8% A vs 53.5%/46.5% NA). The anemic patients (A) tended to be older (74.8 yrs A vs 72.5 yrs NA, p=0.00001), to have more prior hospitalizations (2.0 A vs 1.3 NA, p=0.0001), and to suffer from a more severe CHF. For example, 49.3% of anemic vs only 41% of non-anemic patients were reported to have baseline New York Heart Association (NYHA) class III–IV. Most notably both in-hospital and six-month mortality rates were significantly higher among anemic CHF patients (in-hospital: 6.6% A vs 4.6% NA, p=0.039; six-month: 25% A vs 15% NA, p<0.00001). Interestingly, no difference was observed between the two groups in the percentage of CHF patients taking aspirin prior to admission. However, fewer anemic patients were discharged with aspirin (63.7% A vs 72.7% NA, p=0.00001).

Conclusions: In this large survey of patients with CHF exacerbation, anemia was found to be common and the anemic patients were found to be older, to have more prior hospitalizations, more severe CHF (NYHA class III–IV), and higher in-hospital and six-month mortality rates. Because both groups had similar rates of aspirin usage, it may be suggested that aspirin plays no significant role in the development of anemia in such patients. Thus, the common practice of withholding this medication from anemic CHF patients may deserve reevaluation. Our data call for a prospective clinical trial, which will test the possibility that correction of the anemia (by RBC transfusion or recombinant erythropoietin) can improve the clinical outcome of the anemic CHF patient.

Author notes

Disclosure:Consultancy: Consultant of advisory board. Ownership Interests: BioGal - start up studying Erythropoietin. Honoraria Information: Honorarium for lectures. Membership Information: Member in advisory board.