Heart failure and anemia: Effects on prognostic variables

Gaia Cattadori, Piergiuseppe Agostoni, Ugo Corrà, Gianfranco Sinagra, Fabrizio Veglia, Elisabetta Salvioni, Alice Bonomi, Rocco La Gioia, Angela Beatrice Scardovi, Alessandro Ferraironi, Michele Emdin, Marco Metra, Andrea Di Lenarda, Giuseppe Limongelli, Rosa Raimondo, Federica Re, Marco Guazzi, Romualdo Belardinelli, Gianfranco Parati, Sergio CaravitaDamiano Magrì, Carlo Lombardi, Maria Frigerio, Fabrizio Oliva, Davide Girola, Alessandro Mezzani, Stefania Farina, Massimo Mapelli, Domenico Scrutinio, Giuseppe Pacileo, Anna Apostolo, Anna Maria Iorio, Stefania Paolillo, Pasquale Perrone Filardi, Paola Gargiulo, Maurizio Bussotti, Giovanni Marchese, Michele Correale, Roberto Badagliacca, Susanna Sciomer, Pietro Palermo, Mauro Contini, Pantaleo Giannuzzi, Elisa Battaia, Mariantonietta Cicoira, Francesco Clemenza, Chiara Minà, Simone Maurizio Binno, Claudio Passino, Massimo F. Piepoli

Research output: Contribution to journalArticlepeer-review


Background Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Methods Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (< 11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15 for males) and high (> 15) Hb, respectively. Results Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. Conclusions Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb < 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalEuropean Journal of Internal Medicine
Publication statusPublished - Jan 1 2017


  • Anemia
  • Heart failure
  • Prognosis

ASJC Scopus subject areas

  • Internal Medicine


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