Anand IS et al. (2005) Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation 112: 1121–1127

Although evidence suggests that anemia is common in patients with heart failure (HF) and is linked with increases in mortality and morbidity, the underlying mechanism of action is unclear. In addition, it is not evident whether changes in hemoglobin over time are related to the occurrence of adverse events.

In this retrospective analysis of data from the Valsartan Heart Failure Trial, patients with the largest average decrease in hemoglobin over 12 months (from 142 g/l to 126 g/l) had a significantly greater risk of hospitalization, morbid events and death than the quartile of patients who showed little change in hemoglobin (P≤0.01 for all). Decrease in hemoglobin levels was independently associated with increased risk of death even in those patients who were not anemic at baseline. Interestingly, lack of anemia at baseline and increases in hemoglobin over 12 months were not associated with improved cardiac function. A range of factors, including serum albumin, glomerular filtration rate, blood pressure and C-reactive protein, were independently associated with hemoglobin levels at baseline and over time, suggesting multiple causes of anemia in patients with HF.

The link between changes in hemoglobin levels and mortality and morbidity seen in this study suggests that there might be potential benefits in managing anemia in patients with moderate to severe HF. What constitutes the optimal hemoglobin level and the best way to achieve this level remains to be addressed.