How are anemia and heart failure related?

How are anemia and heart failure related?

Anemia and heart failure are closely related, the former being one of the most prevalent comorbidities and associated with increased mortality among patients.

How are anemia and heart failure related?

Last update: 05 April, 2022

Anemia and heart failure are related. Being anemia one of the most frequent comorbidities in patients with chronic heart failure, especially the decompensated form, it is an important health problem.

According to the World Health Organizationanemia is a condition in which the number of red blood cells or the concentration of hemoglobin within them is lower than normal. Hemoglobin is responsible for transporting oxygen to different tissues.

The prevalence of anemia in heart failure is variable and depends on various factors. However, it is clear that the persistent presence of the clinical picture increases long-term mortality rates in patients.

Defining anemia

When defining anemia, the World Health Organization uses hemoglobin limits as values ​​less than or equal to 12 grams per deciliter in women of menstrual age. And less than or equal to 13 grams per deciliter in men and postmenopausal women.

While in people with chronic kidney failure, the National Kidney Foundation Anemia is defined as hemoglobin less than or equal to 12 grams per deciliter in men and postmenopausal women. Chronic renal failure is also a very common comorbidity in patients with heart failure, due to decreased blood flow to the kidneys.



Prevalence of anemia in heart failure

The prevalence of people with anemia and heart failure differs between the different publications. There is a range that goes from 9.9% to 50%. This variability depends on the differences between the populations studied.

The highest percentage of people with both disorders are elderly and womenwith functional class III-IV (advanced heart failure), under intensive pharmacological treatment, with greater associated comorbidities (hypertension, chronic kidney disease and diabetes mellitis).

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It is clear that the higher the functional class, the higher the percentage of patients with anemia and heart failure. And in women it is almost 2 times more frequent than in men.

Anemia is defined by counting red blood cells or calculating hemoglobin concentration in a laboratory.


various causes

Anemia in heart failure is multicausal. Most of the time, its origin is unknown. However, the most important etiologies are the following:

  • Iron deficiency: it may be due to decreased intake (due to loss of appetite), malabsorption, or chronic losses (such as gastrointestinal bleeding associated with aspirin use).
  • Decreased erythropoietin production: essential hormone responsible for promoting the production of red blood cells in the bone marrow. This may be due to the underlying presence of chronic kidney disease (very common in patients with heart failure) and the use of drugs from the family of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor antagonists (ARBs). .
  • Decreased production of red blood cells in the bone marrow: product of chronic inflammation, which generates substances such as tumor necrosis factor alpha, interleukin 1 and interleukin 6.
  • Hemodilution: in heart failure there is a greater plasma volume, which generates a dilution of the formed elements of the blood.


Treatment is individualized

To establish treatment for anemia, heart failure must be compensated beforehand. Especially if there are signs of congestion due to increased plasma volume.

There is usually an improvement in anemia in heart failure with the prescription of subcutaneous erythropoietin and intravenous iron. In addition, the increase in hemoglobin levels leads to improvement in other symptoms, with increased ejection fraction and less use of diuretics in the long term.

Anemia can decompensate a patient with heart failure to the point of requiring hospitalization for stabilization.

Low doses of erythropoietin are recommended, because it increases the frequency of thrombosis and arterial hypertension.

The effect of anemia on symptoms of heart failure

Anemia is a cause of heart failure decompensation, because it generates repercussions in the transport of oxygen to the different tissues. This aggravates the symptoms of heart failure.

As a way to compensate for the oxygen deficit, changes in the circulatory system are produced. The heart works harder and beats more frequently, leading to tachycardia and abnormal growth of the myocardial walls.

The presence of anemia, heart failure, and chronic renal failure is a very common triad. These types of patients require special and intensive follow-up..

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