Anemia is common in heart failure (HF) patients with its presence apparently associated to a worse prognosis, and as such is described in some studies as an independent predictor of death and hospitalization of patients suffering from systolic and diastolic dysfunction. It remains unknown whether anemia causes the worse evolution of HF patients or whether it is only one marker of a worse heart disease stage. The etiology of anemia is multifactorial and seems to change dependent on the studied population. Factors such as nutritional iron deficiency, presence of kidney failure, intense systematic inflammatory activity, medication use that inhibits the production of erythropoietin or that results in blood loss are the most frequent causes of anemia in heart disease. The prevalence of anemia reported in studies of HF is very variable (from 9 to 79.1%) and is dependent of the studied population, stage of heart disease and method and references used for diagnosis. Iron deficiency is an important etiologic factor which is present in a significant number of patients with the association of anemia and HF. In a study carried out by our group, the incidence of iron deficiency in anemic patients was 61.8%. Hence, anemia is a frequent finding; its presence accentuates the clinical manifestations of HF and is associated to a worse prognosis. An understanding of the cause of anemia makes treatment easier and although there is no consensus on its correction, patients without anemia have a better evolution.
Heart failure; anemia; iron deficiency
