3.1 Effect of anaemia on outcomes

3.1.2 Heart failure

Evidence statements for Acute coronary syndrome

Evidence Statements – heart failure
ES1.4	In patients with heart failure, anaemia is independently associated with mortality.
ES1.5	In patients with heart failure, anaemia may be independently associated with reduced functional or performance status and quality of life.		NA	X

ES, evidence statement

=A; =B; NA,not applicable (see Table 2.1)

The literature search identified three systematic reviews (which did not strictly meet the requirements for Level I evidence, and were therefore not formally included in the review) and 15 prospective cohort studies (Level II evidence). Fourteen studies provided evidence for mortality^15,27-39 and one study provided evidence for functional or performance status or quality of life.⁴⁰

All included studies showed that anaemia (as defined by WHO) was associated with an increased risk of all-cause mortality. The association was particularly strong for studies with more than 1 year of follow-up, with four fair to good-quality studies showing increased risks of mortality of 21 – 47%.^15,27,35,36 Analyses of different Hb concentrations consistently showed that lower Hb concentrations were significantly associated with increased risk of mortality. It was not obvious whether the increased mortality was due to specific cardiovascular events.

One good-quality study assessed the association between various Hb concentrations and functional or performance status using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ).⁴⁰ The study found that low Hb is an independent risk factor for reduced quality of life.