Anemia and Heart Failure: What s the Connection?

anemia and heart failure

Heart Failure and Anemia: How Are They Related?

Anemia can cause stress on the heart and kidneys, and that can lead to damage to both organs and other health problems.

Billions of people around the world and specifically in the United States live with anemia or heart failure, but there’s also a large overlap of people who have both of these conditions.

This overlap is a result of the way that the body’s heart and kidneys work together and their reliance on red blood cells providing oxygen. It’s important to treat these conditions separately and collectively when they develop to help prevent increasingly worsening anemia and heart failure.

Both anemia and heart failure can leave you with:

  • fatigue
  • shortness of breath
  • a fast heartbeat when you’re resting

Other signs that you might have anemia include:

  • headache
  • dizziness
  • pale, dry skin
  • restless leg syndrome

Additional signs that you may be having heart failure are:

  • swelling in the ankles or legs
  • nausea, upset stomach, or bloating
  • dry coughing

Understanding anemia and heart failure

Anemia is a medical term that refers to having low levels of red blood cells in your body. The low levels of red blood cells prevent adequate oxygen from getting to the body’s tissues. You can learn more about this condition here.

Heart failure (also known as congestive heart failure) is a condition where your heart does not pump enough blood out to meet your body’s needs. This happens if your heart cannot fill up with enough blood or if it’s too weak to pump properly. More information about heart failure can be found here.

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Anemia is frequently connected with heart failure. This 2018 research looking at 34 other studies found that anemia was present in a third of individuals with heart failure.

However, the link between anemia and heart failure is a multifactorial one. Researchers remain unclear at this time about the extent to which anemia by itself causes heart failure.

Diagnosing anemia and heart failure typically requires blood tests, medical imaging, and other procedures.

Your doctor will typically order a complete blood count and sometimes a urine test to diagnose anemia. The urine test will reveal if there are abnormal hemoglobin levels. The blood test will show:

  • the number of blood cells
  • the shape of the blood cells
  • if you have low levels of vitamins B12, B9, and iron

To diagnose heart failure, your doctor may order:

  • blood testing that includes a lipid panel and looks at the NT-pro BNP molecule (this blood testing may be used to diagnose anemia as well)
  • chest X-ray
  • echocardiogram
  • electrocardiogram
  • stress test

Iron deficiency is one of the most common causes of anemia. It is also independently associated with an increased risk for mortality in those with heart failure.

Anemia and heart failure are conditions where multiple factors frequently come into play. There is medical research to indicate that an iron deficiency can have a negative impact on both conditions, but its relationship to other factors is still being understood.

The World Health Organization (WHO) has officially classified anemia as hemoglobin (Hb) levels

Diagnostic criteria

The diagnostic criteria for anemia in heart failure patients are serum ferritin levels:

  • less than 30 micrograms per liter (mcg/L) in patients without kidney disease
  • less than 100 mcg/L (or 100–299 mcg/L with passing saturation of less than 20% in patients with chronic kidney disease
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Older research has shown that early correction with erythropoietin (EPO) infusions and iron infusions can improve shortness of breath, fatigue, cardiac function, renal function, and exercise ability.

It can mean fewer hospitalizations and improved quality of life.

Treatment for anemia will depend upon the cause. For example, if the anemia is due to an iron deficiency, common treatment options include:

  • iron supplements
  • intravenous (IV) iron infusions
  • a blood transfusion
  • EPO infusions, which may be recommended if chronic kidney disease is the cause

If you have anemia, your doctor will almost certainly recommend a diet high in iron-rich foods. They’ll also likely recommend that you avoid certain foods that can interfere with absorbing iron like coffee and milk.

There is no cure for heart failure. But medications and lifestyle changes can help to prevent it from getting worse. An older study showed gradual transmission of red blood cells was able to improve heart function in people diagnosed with iron deficiency anemia.

Heart failure and anemia are often found together along with kidney damage. If you have anemia or heart failure, it’s important to speak with your doctor. They can suggest treatments to help increase your red blood cell count and reduce symptoms you may be experiencing from heart failure.

Last medically reviewed on March 14, 2023

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