Mortality in heart failure with Worsening Anemia: A national study

Howard S. Oster, Michal Benderly, Michael Hoffman, Eytan Cohen, Avraham Shotan, Moshe Mittelman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Anemia is common in heart failure (HF), but there is controversy regarding its contribution to morbidity and mortality. Objective: To examine the association of mild and severe anemia with acute HF severity and mortality. Methods: Data were prospectively collected for patients admitted to all departments of medicine and cardiology throughout the country during 2 months in 2003 as part of the Heart Failure Survey in Israel. Anemia was defined as hemoglobin (Hb) < 12 g/dl for women and < 13 g/dl for men; Hb < 10 g/dl was considered severe anemia. Mortality data were obtained from the Israel population registry. Median follow-up was 33.6 months. Results: Of 4102 HF patients, 2332 had acute HF and available hemoglobin data. Anemia was common (55%) and correlated with worse baseline HF. Most signs and symptoms of acute HF were similar among all groups, but mortality was greater in anemic patients. Mortality rates at 6 months were 14.9%, 23.7% and 26.3% for patients with no anemia, mild anemia and severe anemia, respectively (P < 0.0001), and 22.2%, 33.6% and 39.9% at one year, respectively (P < 0.0001). Compared to patients without anemia, multivariable adjusted hazard ratio was 1.35 for mild anemia and 1.50 for severe anemia (95% confidence interval 1.20-1.52 and 1.27-1.77 respectively). Conclusions: Anemia is common in patients with acute HF and is associated with increased mortality correlated with the degree of anemia.

Original languageEnglish
Pages (from-to)368-372
Number of pages5
JournalIsrael Medical Association Journal
Issue number7
StatePublished - Jul 2013


  • Anemia
  • Heart failure (HF)
  • Heart failure survey in israel (HFSIS)
  • Morbidity
  • Mortality
  • New york heart association (NYHA) class


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