Prevalence and Pathogenesis of Anemia in Chronic Heart Failure

Abstract

Anemia is often associated disease in patients with chronic heart failure, which reduces exercise tolerance, quality of life and worsens the prognosis in the patients. The recommendations of the leading associations of cardiology include the correction of iron deficiency and anemia in the context of the treatment of patients with chronic heart failure. Such influence and modern recommendations determine the relevance of knowledge of the prevalence and pathogenesis of anemia and iron-deficiency conditions in chronic heart failure. The purpose of the study was to review the literature illustrating current data about prevalence and pathogenesis of anemia and iron deficiency in patients with chronic heart failure. Materials and methods. This work presents review of literature about prevalence and pathogenesis of anemia and iron deficiency in patients with chronic heart failure, based on a search of English-language articles in the PubMed database for the last 20 years, by keywords – anemia, iron deficiency, chronic heart failure, pathogenesis, prevalence. Results and discussion. The frequency of anemia that patients with chronic heart failure ranges have are from 4% to 30-70% of cases, according to several studies. Such a variety of data is associated with different degrees of severity of heart failure in different studies, but they unanimously confirm the information about the significant prevalence of this condition in the studied population cohort. Iron deficiency is an important comorbid condition that patients with heart failure have and is observed in an average of 30-50% of cases, according to some data, the frequency reaches a maximum of 70-83%. Iron deficiency is the most common cause of anemia, but it is particularly interesting that approximately 46% of patients with iron deficiency do not have anemia. The following 6 factors that can be the cause of anemia individually or in combination that patients with chronic heart failure have, have been identified: iron deficiency, inflammation, erythropoietin level, medications, hemodilution, medullary dysfunction. The causes of absolute iron deficiency are anorexia, cachexia, malabsorption of iron due to intestinal edema and hepcidin-induced suppression of iron transporters, such as ferroportin, functional – chronic inflammatory state, which leads to an increase in the level of pro-inflammatory cytokines, such as interleukin-1, interleukin-6, interleukin-18, tumor necrosis factor-, which, in turn, induces the synthesis of hepcidin and, accordingly, decreases the expression of ferroportin with a decrease in the transition of iron into the state of circulation and stimulation of sequestration in macrophages of the reticuloendothelial system. Conclusion. Better understanding of the pathogenesis of these conditions that patients with chronic heart failure have, will allow the development of new methods of treatment

Chronic Heart Failure of Ishemic Etiology: Gender Differences and Comorbidities

“…The incidence of anaemia in patients with CHF ranges from 4% to 30-70% of cases, according to several studies. Such a variety of data is associated with different degrees of heart failure severity in different studies, but they unanimously confirm the significant prevalence of this condition in the study population [16]. Approximately the same percentage of the comorbidities mentioned above was found in patients with HFrEF: nonalcoholic fatty liver disease was diagnosed in 45.9% of patients, CKD in 26.2%, thyroid dysfunction in 21.3%, and anaemia in 4.9%, respectively (table 4).…”

“…але вони одноголосно підтверджують інформацію про значну поширеність цього стану в досліджуваній когорті населення [16]. Приблизно такий же відсоток вищезазначеної супутньої патології був виявлений у хворих із СН-нФВ: неалкогольна жирова хвороба печінки встановлена у 45,9% пацієнтів, ХХН -у 26,2%, порушення функції щитоподібної залози -у 21,3%, анемія -у 4,9% відповідно (таблиця 4).…”