Anemia, heart failure and evidence-based clinical management

The Interplay of Comorbidities in Chronic Heart Failure: Challenges and Solutions

BACKGROUND

Chronic heart failure (HF) is frequently associated with various comorbidities. These comorbid conditions, such as anemia, diabetes mellitus, renal insufficiency, and sleep apnea, can significantly impact the prognosis of patients with HF.

OBJECTIVE

This review aims to synthesize current evidence on the prevalence, impact, and management of comorbidities in patients with chronic HF.

METHODS

A comprehensive review was conducted, with a rigorous selection process. Out of an initial pool of 59,030 articles identified across various research modalities, 134 articles were chosen for inclusion. The selection spanned various research methods, from randomized controlled trials to observational studies.

RESULTS

Comorbidities are highly prevalent in patients with HF and contribute to increased hospitalization rates and mortality. Despite advances in therapies for HF with reduced ejection fraction, options for treating HF with preserved ejection fraction remain sparse. Existing treatment protocols often lack standardization, reflecting a limited understanding of the intricate relationships between HF and associated comorbidities.

CONCLUSION

There is a pressing need for a multidisciplinary, tailored approach to manage HF and its intricate comorbidities. This review underscores the importance of ongoing research efforts to devise targeted treatment strategies for HF patients with various comorbid conditions.

Anemia and Heart Failure: A Narrative Review

Anemia in heart failure patients is a relatively common finding and has been linked with an increased risk of hospital admissions, morbidities, and significant mortality making its correction a significant factor in improving the quality of life and clinical outcomes in those suffering from it. This review article has discussed the multifactorial pathophysiology, including iron deficiency, longstanding inflammation, abnormal levels of human erythropoietin (Epo), and the abnormal activation of the renin-angiotensin-aldosterone system (RAAS) being the most significant. The diagnostic guidelines as well as research-based management modalities specifically with iron supplements and erythropoietin stimulating agents have also been discussed, although research done in this area has been limited and shown conflicting results.

Prevalence of Anemia and Associated Factors Among "Apparently Healthy" Urban and Rural Residents in Ethiopia: A Comparative Cross-Sectional Study

Background

Anemia is the most frequent micronutrient deficiency; globally it has an impact on more than 2 billion people. Different studies have indicated that the prevalence of anemia varies between rural areas and urban centers. This study focused on determining the prevalence and identifying the factors associated with anemia among “apparently healthy” urban and rural residents of Gilgel Gibe Field Research Center.

Methods and Participants

A comparative cross-sectional study was done using secondary data of Gilgel Gibe Field Research Center. Data of 1,602 (1,258 rural and 344 urban) apparently healthy adults whose hemoglobin level was available were included in the analysis. Data were analyzed by SPSS 20 and separate logistic regression models; urban and rural were fitted. Statistical significance was set at p-values < 0.05 with 95% CI.

Results

The overall prevalence of anemia was 40.9%. Anemia was higher among rural residents (46.6%) than urban residents (20.1%). In urban centers, being male (AOR = 2.15, 95% CI: [1.03, 4.50]) and illiterate (AOR = 5.76, 95% [CI: 1.27, 26.07]) were significantly associated with anemia. In rural areas, being female (AOR = 1.78, 95% CI: [1.27, 2.52]), presence of heart disease (AOR = 2.63, 95% CI: [1.09, 6.33]), central obesity (AOR = 1.83, 95% CI: [1.31, 2.57]), illiteracy (AOR = 3.62, 95% CI: [1.57, 8.35]), and primary school completion (AOR = 2.69, 95% CI: [1.08, 6.73]) were significantly associated with anemia.

Conclusion

According to the WHO classification, the overall prevalence of anemia was a severe public health problem. This study also marked urban–rural variation in anemia prevalence, indicating the need for targeting specific areas for intervention. Strengthening strategies aimed at educational empowerment and nutritional education will have a contribution to combating anemia, especially in the rural kebeles of the study area.

The Role of Nutritional Status in Elderly Patients with Heart Failure

Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.