An Evaluation of the Causes of Anemia in Patients With Heart Failure

Inclusion criteria

Groups 1 and 2

• Age >18 years
• Group 1: hemoglobin < 120g/L in women and < 130 g/L in men (in agreement with the WHO definition of anemia)
• Group 2: hemoglobin > or = 120g/L in women and > or = 130 g/L in men
• Patients with chronic HF referred to a specialized HF clinic, or with a diagnosis of HF at least 6 months prior to enrolment
• NYHA functional class II-IV at the time of enrolment
• Patients already on CHF medical therapy (ACEI or ARBs, beta-blockers if tolerated, with or without digoxin, and loop diuretics), at stable doses for > or = 1 month
• LVEF < or = 40% within 6 months prior to patient enrolment, by echocardiography, radionuclide ventriculography or perfusion scan, or radiologic angiography

Inclusion criteria

- group 3

• Age >18 years
• At least moderate CRF (eGFR < 60ml/min/1,73m2)
• With or without anemia
• LVEF > or = 50% within 6 months prior to patient enrolment, by echocardiography, radionuclide ventriculography or perfusion scan, or radiologic angiography

Exclusion criteria

(all groups):

• Recent acute renal failure episode (< 1 month)
• Red blood cells (or other blood component) transfusions or EPO therapy within 3 months prior to enrolment
• Iron, B12 or folic acid supplements used to treat anemia (< 3 months)
• Evidence of active GI bleeding
• Recent acute coronary syndrome or decompensated HF episode (< 1 month)
• Complex congenital heart disease
• Known malignant hematologic or other active neoplasia
• Immunosuppressive therapy, chemotherapy or radiotherapy within 3 months prior to enrolment
• Recent acute decompensation of a chronic inflammatory disease (e.g. chronic inflammatory bowel disease, rheumatoid arthritis, collagen vascular disease) within 3 months prior to enrolment
• Recent viral or bacterial syndrome (< 2 weeks)
• Active or recent viral hepatitis (< 3 months)
• Pregnant women
• Potential for non compliance to tests involved in this protocol
• Incapacity to provide informed consent