Anaemia in chronic heart failure: what is its frequency in the UK and its underlying causes?

In two recent studies from Israel, Silverberg and colleagues noted that anaemia was common in chronic heart failure (CHF). 2 Moreover, treatment with combined erythropoietin and intravenous ferrous sulfate not only increased haemoglobin concentrations but, more importantly, was associated with improvements in cardiac function, New York Heart Association (NYHA) functional class, renal function, and falls in the need for diuretics and hospitalisation. The importance of anaemia in CHF was recently highlighted by data from the SOLVD study where anaemia was found to be a risk factor for mortality. Two questions now arise. Firstly, how common is anaemia in CHF patients in the UK? Secondly, what causes this anaemia in CHF? This second question is pertinent because there are numerous possible causes of anaemia in such patients. For example, aspirin use is widespread in CHF patients, raising the possibility of iron deficiency anaemia. Renal dysfunction is also common, raising the possibility of an anaemia of chronic disorder. Since CHF patients are elderly, coincidental hypothyroidism or pernicious anaemia could also contribute to the anaemia. We therefore set out to assess these two questions retrospectively. After all, erythropoietin would not be an appropriate treatment in CHF anaemia where iron deficiency or pernicious anaemia were identified as the cause of the anaemia.