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Prevalence of anemia and associated factors in patients with heart failure admitted to Jimma university medical center

BMC Cardiovascular Disorders volume 25, Article number: 253 (2025) Cite this article

A Correction to this article was published on 25 April 2025

This article has been updated

Abstract

Background

Anemia is common among adults with heart failure and is linked to increased risks of illness, decreased physical abilities, lower quality of life, more hospital visits, and higher mortality rates. In Ethiopia, about 23% of reproductive-age women and 18% of adult men suffer from anemia. However, data is lacking about its prevalence and associated factors in admitted heart failure patients in our setup.

Objectives

To determine the prevalence of anemia and associated factors in heart failure patients who were admitted to the emergency and medical ward at Jimma University Medical Center, Southwest Ethiopia.

Methods

A cross-sectional study was conducted among all heart failure patients admitted to Jimma University Medical Centre from September 1, 2023, to February 30, 2024. A complete blood count was done for these patients. The demographic data and clinical characteristics of study participants were collected using a structured questionnaire. Data was collected on patients’ admission and discharge and then data was cleared and entered into a computer using SPSS software version 26. Logistic regression was conducted to declare statistically significant variables with anemia at p-value < 0.05 with 95% CI of Adjusted odds ratio.

Results

A total of 269 participants were involved in the analysis with a mean age of 50.39 ± 18.08 years. The prevalence of anemia among patients with heart failure was 49.8% (43.7-55.9%). Anemia was statistically significant with hypokalaemia: AOR%CI; 3.88(1.6–9.43), creatinine level: AOR%CI; 3.58(1.74–7.38), re-admission: AOR%CI; 3.7(1.63–8.39), and length of hospital stay AOR%CI; 4.11(2.18–7.78).

Conclusion

In the current study, nearly half of admitted heart failure patients had anemia, which is associated with hypokalaemia, high creatinine level, readmission, and a longer duration of hospital stay. There was a high prevalence and clinical impact of anemia heart failure patients in our study.

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Introduction

Heart failure (HF) is a complex and potentially fatal illness that is marked by high expenses, severe morbidity and mortality, reduced functional ability, and poor quality of life [1]. It affects 6.2 million individuals over the age of 20 or 2.2% of the population in the United States alone. In 2013–2016, more than 20 million people worldwide were living with HF. Heart failure with decreased ejection fraction (HFrEF) makes for about half of the HF population [2].

Anaemia is an independent prognostic factor for mortality in chronic HF and is associated with higher rates of mortality, hospitalization, and re-admission. Anaemia is a powerful independent predictor of death and hospitalization in systolic and diastolic dysfunction [3,4,5,6,7,8]. The prevalence of anemia in heart failure varies according to age, sex, severity of heart failure, and presence of other comorbid illnesses [9]. It is associated with an increased frequency of hospitalization and higher morbidities and mortalities, so its early correction improves the quality of life and clinical outcomes [10].

The World Health Organization defines anemia as hemoglobin (Hb) levels < 12 g/dL in women and < 13 g/dL in men. However, the categorization may vary depending on age, pregnancy status, altitude, and smoking status [11]. The diagnostic criteria for anemia in patients with heart failure are serum ferritin levels of less than 30 mcg/L in patients without kidney disease and less than 100 mcg/L in patients with chronic kidney disease, or ferritin levels in serum from 100 to 299 mcg /L with passing saturation less than 20% in patients with chronic kidney disease [12]. Anemia in heart failure patients ranges from 9% to 69.6%, with roughly 46.8% of patients having a higher risk of hospitalization and death compared to 29.5% in nonanemic patients [13]. Other co-morbid medical problems, such as chronic kidney disease (CKD), advanced age, and the severity of heart failure, have also been associated with an increased prevalence of anemia ( [12].

Current therapy options for anemia in heart failure patients include erythropoietic medications (epoetin-α, epoetin-β, and darbepoetin-α) and iron supplements [14]. The significance of blood transfusion in patients with heart failure is controversial, with varying “transfusion thresholds” in patients with cardiovascular disorders, doubtful advantages in lowering mortality, and the presence of negative side effects. Blood transfusion can be seen as an immediate therapy for severe anemia on an individual basis, but it does not appear to be a feasible therapeutic strategy for the long-term management of chronic anemia in CHF, based on the risk-benefit profile [9].

Anemia in heart failure patients is caused by a combination of factors, including iron deficiency (ID) anemia, chronic inflammation, and low erythropoietin levels. Pseudo-anemia caused by renin angiotensin aldosterone system (RAAS) activation might also be a contributing factor. The usage of Angiotensin converting enzyme inhibitor (ACEI) and Angiotensin receptor blocker (ARB) is also related to anemia due to impaired EPO production and decreased marrow proliferation [15, 16].

Data regarding the prevalence of heart failure in community settings in African countries is scarce, but some studies indicate that HF accounts for 3–5% of medical admissions in these countries. These studies have shown that 75% of the etiologies of HF in Africa are non-ischemic in origin, although the contribution of ischemic heart disease has been rising recently [17]. There is no adequate data about the prevalence of HF in Ethiopian settings. Still, valvular heart disease accounts for most of the admissions with HF in hospital-based studies. Also, there is a limited report on the prevalence of anemia among patients with heart failure. Therefore, this study aims to determine the prevalence of anemia and associated factors in patients with heart failure admitted to Jimma University Medical Centre.

Materials and methods

Study area, design, and period

The study was conducted at Jimma University Medical Center (JUMC), which is located in Oromia Regional State and 352 km from the capital city of Ethiopia, Addis Ababa. It is the only medical center in southwest Ethiopia. The medical services provided include internal medicine, which has a total of 100 beds with 2781 annual admissions, including cardiology inpatient and outpatient units, oncology, surgery, orthopedics, ophthalmology, pediatrics, gynecology, obstetrics, dermatology, psychiatric services, pathology, pharmacy, medical laboratory, intensive care unit, radiology, and others as both inpatient and outpatient services. A cross-sectional study design was conducted from September 1, 2023- February 30, 2024 GC.

Study participants

All heart failure patients admitted to JUMC during the study period were used as the source population. The study population included all patients of age ≥ 15 years with heart failure who were admitted to the emergency and medical wards of JUMC, and who met the specific inclusion criteria.

Eligibility criteria

The study included patients who have been diagnosed with HF and are aged ≥ 15 years. Meanwhile, Pregnant women, Patients who were on iron supplementation, and those who received blood and blood products were excluded from the study.

Sample size determination and sampling technique

Sample size determination

The sample size was calculated using a single population formula using the following assumptions: The prevalence of anemia in admitted patients is 41.90% [18], and the margin of error, d, is set at 5%, resulting in a sample size of 372. Since, the total number of patients expected to be admitted to the emergency department and medical ward during one one-year period was 700 patients the final sample size was adjusted using the correction formula and a total of 269, including 10% of non-responders.

Sampling technique

A consecutive sampling technique was employed until the final sample size was reached.

Data collection tool and procedure

Data was collected by using structured questionnaires which included, demographic factors, etiology of HF, New York Heart Association (NYHA) functional classification, other comorbidities, use of ACEI/ARB, precipitating factors, length of hospital stay, and hospital discharge outcome. In the second part, echocardiography was performed to identify left ventricular ejection fraction (LVEF). The diagnosis of heart failure was done after a detailed clinical examination, laboratory findings, and measurement of left ventricular ejection fraction (LVEF) by echocardiography. The classification of Heart failure was done as Heart failure with reduced ejection fraction (EF) (HFrEF) [LVEF]: ≤40%), HF with mildly reduced EF (HFmrEF) (LVEF: 41–49%), HF with preserved EF (HFpEF) (LVEF: ≥50%), and HF with improved EF [19].

Blood samples were drawn for investigation on the day of presentation to the hospital. Hemoglobin was done by Beckman Coulter automated hematology analyzer and other relevant investigations were also performed. Anaemia was defined based on WHO classification, Anemia: was defined as Hgb < 12 g/dl for non-pregnant females and < 13 g/dl in males. Mild anemia in men-11–12.9 g/dl, moderate anemia-8–10.9 g/dl and severe < 8 g/dl, Mild anemia in women-11–11.9 g/dl, moderate 8–10.9 g/dl, and severe < 8 g/dl, Microcytic anemia is defined as anemia with a low MCV value (< 80 fl.), Normocytic anemia is defined as anemia with a normal MCV value(80–100 fl.), and Macrocytic anemia is defined as anemia with a high MCV value(> 100 fl.) [11]. CKD-staging, based on eGFR as suggested by KDIGO and determined by 2021 CKD EPI formula: Stage G1- ≥ 90, Stage G2- 60-89, Stage G3 -30-59, and Stage G4–15-29 and Stage G5-  < 15 [20].

Data processing and analysis

The data was analyzed using the Statistical Package for Social Science (SPSS) version 26 software. Bivariate logistic regression was conducted to assess the strength of the association between the dependent and independent variables. Those variables with a p-value of < 0.25 in the bivariate logistic regression analysis were fitted into the multivariate logistic regression analysis [21]. A significance level of p < 0.05 was used to determine statistical significance.

Data quality management

Data quality was managed by training the data collectors and filling out the structured checklist with the appropriate data from patient interviews and patient records. A pre-test was done two weeks before actual data collection to check its clarity and completeness, and the necessary corrections were made accordingly. Standard operating procedures (SOPs) were developed and implemented for pre-analytical, analytical, and post-analytical procedures. To achieve accurate results with the Beckman Coulter hematological analyzer, commercially available quality controls (High, Medium, and Low) were used daily during startup.

Results

Socio-demographic and patient clinical characteristics

A total of two hundred sixty-nine heart failure patients were included in the study. More than half of the participants (61.7%) were male, with a mean age of 50.39 ± 18.08 yrs. Most of the patients (79.2%) had not been previously admitted. Ischemic Heart disease was the most common cause of HF accounting for 99(36.8%) of patients, followed by chronic rheumatic valvular heart disease; 67(24.9%), idiopathic dilated cardiomyopathy 63(23.4%), Hypertensive heart disease 17(6.3%) and degenerative valvular heart disease 15(5.6%). Twenty-one (7.8%) of patients have diabetes and seventy-nine (29.4%) patients have hypertension. Most of the patients (93.7%) had Stage C/NYHA class III-IV heart failure and (45%) of admitted patients had LV ejection fraction (LVEF ≤ 40%). The most common precipitating factor for HF was pneumonia (44.2%), followed by atrial fibrillation (Afib) (16%) (Table 1).

Table 1 Characteristics of patients with heart failure admitted at JUMC, 2024 (n = 269)
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Comparison between anemic and Non-Anemic patients on different variables

The statistically significant mean difference was obtained between anemic and non-anemic patients with heart failure on Hgb level, mean length of hospital stays in days, age, systolic blood pressure, diastolic blood pressure, creatinine level, eGFR, and sodium level (p-value < 0.05). Anemic patients were slightly younger than non-anemic patients indicating negative association between age and anemia status (p-value = 0.017). Anemic patients had lower SBP and DBP compared to non-anemic patients with p-value of 0.026 for both. As expected, hemoglobin levels were significantly lower in anemic patients compared to non-anemic patients (p-value = < 0.001). Anemic patients had higher creatinine levels and lower eGFR compared to non-anemic patients with p-value of < 0.001 for both. Anemic patients had lower sodium levels and a longer mean hospital stay compared to non-anemic patients with p-value of 0.028 and 0.001 respectively. (Table 2).

Table 2 Comparison of mean demographics, selected haematological and biochemical parameters in heart failure patients with and without anemia at JUMC, 2024 (n = 269)
Full size table

Prevalence of Anemia among patients with heart failure

The prevalence of anemia among patients with heart failure was 49.8% (43.7-55.9%). Among anemic patients, majority of (67.2%) were males, while female non-anemic patients constitute 43.7% (Fig. 1).

Fig. 1
figure 1

Sex differences in the proportion of anemia among patients admitted to JUMC, 2024

Full size image

Types and severity of Anemia among heart failure patients

Among anemic heart failure patients,63(47%%) of patients had mild anemia, 52(38.8%) had moderate anemia and 19(14.2%) of patients had severe anemia (Hgb < 8 g/dl). Based on MCV classification, among heart failure patients, 39(29.1%) had microcytic anemia, 92(68.7%) had normocytic anemia, and 3(2.2%) had macrocytic anemia. (Table 3)

Table 3 Types and severity of anemia among patients with heart failure admitted to JUMC, 2024 (n = 269)
Full size table

Predictors of Anemia among patients with admitted heart failure

In the Bivariable logistic regression, the age of the patients, sex, previous history of hypertension, NYHA class, eGFR, readmission, creatinine level, potassium level, sodium level, and length of hospital stay were candidate for multivariable logistic regression analysis at the level of significance of 0.25.

In a multivariable logistic regression analysis, five significant predictors of anemia in patients with heart failure were identified. Potassium: AOR%CI; 3.88(1.6–9.43), creatinine level: AOR%CI; 3.58(1.74–7.38), re-admission: AOR%CI; 3.7(1.63–8.39), and length of hospital stay AOR%CI; 4.11(2.17–7.78). (Table 4).

Table 4 Bivariable and multivariable logistic regression analysis of anemia among patients with heart failure admitted at JUMC, 2024 (n = 269)
Full size table

Discussion

This study aimed to determine the prevalence of anemia in patients with heart failure. Our results show that the overall prevalence of anemia is 49.8% in HF patients. The prevalence of anemia in our study was in line with a study conducted in Cameroon which had a prevalence of 49.5% [22]. But, our finding is higher than the study conducted at Gondar with a prevalence of 41.9% [23] and Congo at 42% [18], and lower than 64.3% reported in Uganda [24]. In the literature, the prevalence of anemia is variable, from 4 to 61%, with the majority of studies finding it between 18 and 20% [9, 25, 26]. This large variability may be explained by methodological differences, due mainly to the definition of anemia [7, 8, 27].

In our study, creatinine level, and length of hospital stay were significantly higher among heart failure subjects with anemia than those without anemia. However, age, systolic blood pressure, diastolic blood pressure, hemoglobin level, glomerular filtration rate, and sodium level were significantly lower among heart failure subjects with anemia than those without anemia. This finding was also similar to the study done in Nigeria [28]. In this study, patients with heart failure who had anemia were notably younger than those who did not have anemia, indicating that anemia is more common in younger individuals. This might be because young age is a risk factor for increased frequency of risk factors and progression of factors that can contribute to anemia, including nutritional deficiency, recurrent infections, and progressive blood loss [18]. Anemia decreases hemoglobin concentration, lowering blood viscosity. This reduces peripheral vascular resistance (afterload), allowing the heart to pump blood more easily but at the expense of reduced arterial pressure. Decreased afterload reduces the force required during ventricular contraction, lowering systolic pressure and reduced resistance in peripheral vessels diminishes diastolic filling pressure [29, 30]. These (GFR, creatinine levels, and sodium levels) are closely related to renal dysfunction because as glomerular filtration decreases, the volume of fluid in our body increases (hyponatremia), and creatinine clearance decreases. Moreover, renal dysfunction will result in decreased erythropoietin synthesis which will affect red blood cell production and haemoglobin concentration [5, 31].

In our findings, the most common types of anemia are Normocytic anemia 92(68.7%) followed by Microcytic anemia 39(29.1%), similar report was found in a study conducted in Nepal [32] but, a study done in the Republic of Congo reported that the most common types of anemia were microcytic anemia 52.6% followed by normocytic anemia 35.1% [33]. This difference might be due to the difference in causes of anemia. From a pathophysiological perspective, anemia of chronic disease is influenced by inflammatory cytokines such as TNFα and IL6. Thus, the anticipated morphological feature of anemia in individuals with heart failure would be anemia of chronic disease, which is normocytic and normochromic [34].

Hypokalaemia is statistically significant associated factor for the prevalence of anemia in heart failure patients. This study finding is similar to a study conducted in Japan [35]. The possible reason might be due to hypokalemia often activates the RAAS, which can lead to sodium and water retention but may also result in a relative deficiency of erythropoietin due to renal ischemia from fluid overload and reduced perfusion pressure [36]. In our study, patients with high creatinine levels were 3.58 times more likely to develop anemia than patients with normal creatinine. Our finding is similar to a study conducted in Ethiopia [23]. This might be due to renal abnormality in which creatinine will be high which will result in decreased erythropoietin production which will decrease red blood cell production and hemoglobin level [31].

Readmission is a statistically significant risk factor for anemia development in heart failure. Patients with a history of readmission had a 3.7 times higher probability of developing anemia than those with no previous admission. This result was consistent with a research done in Japan, which indicated that readmission was associated with the development of anemia [37]. During rehospitalization, patients may undergo various medical procedures that can lead to blood loss, such as diagnostic tests or surgical interventions. This blood loss can contribute to a decrease in hemoglobin levels, resulting in anemia [38]. In our study, patients who stayed for more than or equal to 8 days were 4.11 times more likely to develop anemia than those who stayed less than 8 days., which is also reported by the study done in the USA [39]. The more increase in length of hospital stays, the more chances of developing anemia in heart failure. This might be due to, Prolonged hospitalization often involves multiple diagnostic and therapeutic interventions, such as blood draws, catheter placements, and surgeries. These procedures can lead to cumulative blood loss, which directly reduces hemoglobin levels, contributing to anemia. Studies have shown that patients with longer hospital stays are at higher risk for such complications, leading to decreased red blood cell counts and hemoglobin levels [10].

Our study has some limitations: the study was conducted in a single center so it might be difficult to represent the nationwide prevalence of anemia and associated factors in admitted heart failure patients and generalizability to the other center might be taken in caution. While the study provides valuable insights, its small size raises concerns about generalizability of the results, suggesting the need for further research with large sample size. This study did not assess screening investigation for iron deficiency anemia because the most common cause of anemia in heart failure is iron deficiency anemia. Despite these limitations, this study may provide prominent information on the prevalence of anemia and associated factors in admitted heart failure patients in our setup.

Conclusions

The overall prevalence of anemia is 49.8% in HF patients. Hypokalaemia, high creatinine levels, readmission, and prolonged hospitalization are factors associated with the prevalence of anemia in heart failure. Early screening, follow-up, and treatment of anemia in patients with HF can reduce the number of anemic patients in this population, thus minimizing the burden of anemia in patients with HF. Moreover, a study with a larger sample size and multicenter approach will be required to further strengthen the current findings and to explore more on etiologies of anemia in HF patients in our setup including measurement of iron studies.

Data availability

All data generated or analyzed during the current study are available from the corresponding author upon reasonable request.

Change history

  • 22 April 2025

    The original online version of this article was revised: In the sentence beginning ‘CKD-staging, based on eGFR .......... and Stage G5- < 15 [20].’ in the Data collection tool and procedure heading, the numbers in ‘Stage G3 -30-59 59, and Stage G4–15–29 30’ are incorrect and has been updated.

  • 25 April 2025

    A Correction to this paper has been published: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04772-y

Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

CRVHD:

Chronic rheumatic valvular heart disease

CKD:

Chronic kidney disease

DVD:

Degenerative valve disease

GFR:

Glomerular filtration rate

HF:

Heart failure

HFrEF:

Heart failure with decreased ejection fraction

Hb:

Hemoglobin

HHD:

Hypertensive heart disease

ID:

Iron deficiency

IHD:

Ischemic heart disease

JUMC:

Jimma University Medical Center

LVEF:

Left ventricular ejection fraction

MCV:

Mean cell volume

NYHA:

New York Heart Association

RAAS:

Renin angiotensin aldosterone system

References

  1. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2022;118(17):3272–87.

    Article  CAS  Google Scholar 

  2. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139:56–528.

  3. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: The prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003;41(11):1933–9. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0735-1097(03)00425-X

  4. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38(4):955–62. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0735-1097(01)01470-X

  5. O’Meara E, Clayton T, McEntegart MB, McMurray JJV, Lang CC, Roger SD, et al. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure - Results of the Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Circulation. 2006;113(7):986–94.

    Article  PubMed  Google Scholar 

  6. Felker GM, Shaw LK, Stough WG, O’Connor CM. Anemia in patients with heart failure and preserved systolic function. Am Heart J. 2006;151(2):457–62.

    Article  PubMed  Google Scholar 

  7. Kosiborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM. The prognostic importance of anemia in patients with heart failure. Am J Med. 2003;114(2):112–9.

    Article  PubMed  Google Scholar 

  8. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002;39(11):1780–6. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0735-1097(02)01854-5

  9. Schejbalová M, Niederle P. Anaemia in chronic heart failure. Prakt Lek. 2006;86(11):642–6.

    Google Scholar 

  10. Siddiqui SW, Ashok T, Patni N, Fatima M, Lamis A, Anne KK. Anemia and heart failure: A narrative review. Cureus. 2022;14(Id):1–10.

    CAS  Google Scholar 

  11. Who CM. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ. 2011;1–6. Available from: http://scholar.google.com/scholar?hl=en%26;btnG=Search%26;q=intitle:Haemoglobin+concentrations+for+the+diagnosis+of+anaemia+and+assessment+of+severity#1

  12. Pereira CA, Roscani MG, Zanati SG, Matsubara BB. Anemia, heart failure and evidence-based clinical management. Arq Bras Cardiol. 2013;101(1):87–92.

    PubMed  PubMed Central  Google Scholar 

  13. Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, et al. Anemia and mortality in heart failure patients. A systematic review and Meta-Analysis. J Am Coll Cardiol. 2008;52(10):818–27.

    Article  PubMed  Google Scholar 

  14. Ganz T, Nemeth E. Anemia of chronic disease. Mol Hematol. 2024;169–73.

  15. Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J. 2005;26(21):2232–7.

    Article  CAS  PubMed  Google Scholar 

  16. Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W et al. Iron deficiency in chronic heart failure: An international pooled analysis. Am Heart J. 2013;165(4):575–582.e3. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ahj.2013.01.017

  17. Nyaga UF, Bigna JJ, Agbor VN, Essouma M, Ntusi NAB, Noubiap JJ. Data on the epidemiology of heart failure in Sub-Saharan Africa. Data Br. 2018;17:1218–39. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.dib.2018.01.100

  18. Ikama MS, Nsitou BM, Kocko I, Mongo NS, Kimbally-Kaky G, Nkoua JL. Prevalence of anaemia among patients with heart failure at the Brazzaville university hospital. Cardiovasc J Afr. 2015;26(3):140–2.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification Of heart failure: a report Of the heart failure society Of America, heart failure association Of the European society Of cardiology, Japanese heart failure society and writing committee Of the universal definition O. Eur J Heart Fail. 2021;23(3):352–80.

    Article  PubMed  Google Scholar 

  20. Campillo CR, Sanz De Pedro MP, Barcelo SA, Bajo Rubio MA, Soto AB, Rioja RG. Differences in glomerular filtration rate estimated with the new eGFRcr CKD EPI age and sex 2021 vs. the eGFRcr CKD EPI 2009 formula. Adv Lab Med. 2022;3(3):313–4.

    PubMed  PubMed Central  Google Scholar 

  21. Zhang Z. Model Building strategy for logistic regression: purposeful selection. Ann Transl Med. 2016;4(6):4–10.

    Article  Google Scholar 

  22. Nganou-Gnindjio C, Pieme A, Nanfack-Géondo C, Angong D, Hamadou B, Amougou SLE, et al. Prevalence and factors associated with anemia in patients with heart failure in Sub-saharan Africa, Cameroon. Arch Cardiovasc Dis Suppl. 2020;12:51–2.

    Google Scholar 

  23. Abebe TB, Gebreyohannes EA, Bhagavathula AS, Tefera YG, Abegaz TM. Anemia in severe heart failure patients: does it predict prognosis? BMC Cardiovasc Disord. 2017;17(1):1–7.

    Article  Google Scholar 

  24. Kuule JK, Seremba E, Freers J. Anaemia among patients with congestive cardiac failure in Uganda - its impact on treatment outcomes. S Afr Med J. 2009;99(12):876–80.

    PubMed  Google Scholar 

  25. Man-Fai Sim V, Nam MCYY, Riley S, Yousef Z, Hurley J, Cheung WY, et al. Anaemia in older people with chronic heart failure: the potential cost. Technol Heal Care. 2009;17(5–6):377–85.

    Article  Google Scholar 

  26. Drakos SG, Anastasiou-nana MI, Malliaras KG, Nanas JN. Anemia in chronic heart failure. Congest Hear Fail. 2009;15(2):87–92.

    Article  CAS  Google Scholar 

  27. Kalra PR, Collier T, Cowie MR, Fox KF, Wood DA, Poole-Wilson PA, et al. Haemoglobin concentration and prognosis in new cases of heart failure. Lancet (London England). 2003;362(9379):211–2.

    Article  CAS  PubMed  Google Scholar 

  28. Akintunde AA, Aworanti OW, Transfusion B, PATTERN OF ANAEMIA, AND ITS CORRELATES IN NIGERIANS WITH HEART FAILURE. 2020;18(1):51–9.

  29. Anand IS, Gupta P. Anemia and iron deficiency in heart failure: current concepts and emerging therapies. Circulation. 2018;138(1):80–98.

    Article  CAS  PubMed  Google Scholar 

  30. Gela YY, Belay DG, Chilot D, Andualem AA, Bitew DA, Sinamaw D et al. Prevalence of anemia and associated factors among adult hypertensive patients in Referral Hospitals, Amhara Regional State. Sci Rep. 2023;13(1):1–9. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41598-023-41553-z

  31. Tymińska A, Kapłon-Cieślicka A, Ozierański K, Peller M, Balsam P, Marchel M, et al. Anemia at hospital admission and its relation to outcomes in patients with heart failure (from the Polish cohort of 2 European society of cardiology heart failure Registries). Am J Cardiol. 2017;119(12):2021–9.

    Article  PubMed  Google Scholar 

  32. Bista M, Mehta RK, Parajuli SB, Shah P. Prevalence of anemia and associated factors among patients with heart failure at Birat. Med Coll Teach Hosp. 2023;20(1):43–8.

    Google Scholar 

  33. Ikama SM, Memougame JM, Oko T, Makani J, Ngolet LO, Moualengue B et al. Epidemiological and prognostic aspects of anemia during heart failure in Brazzaville (The Republic of the Congo). 2023;396–403.

  34. Cavalini WLP, Ceulemans N, Correa RB, Padoani PW, Delfrate EFG, Maluf EMCP. Prevalence of anemia in patients with heart failure. Int J Cardiovasc Sci. 2016;29(1):6–12.

    Google Scholar 

  35. Otaki Y, Watanabe T, Yamaguchi R, Tachibana S, Sato J, Kato S, et al. Hypokalemia, kidney function, and clinical outcomes in heart failure with preserved ejection fraction. Circ J. 2024;88(1):117–26.

    Article  CAS  Google Scholar 

  36. Cooper LB, Benson L, Mentz RJ, Savarese G, DeVore AD, Carrero JJ, et al. Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish heart failure registry. Eur J Heart Fail. 2020;22(8):1390–8.

    Article  CAS  PubMed  Google Scholar 

  37. Amano S, Ohta R, Sano C. Relationship between anemia and readmission among older patients in rural community hospitals: A retrospective cohort study. J Clin Med. 2024;13(2).

  38. Kosiborod M, Curtis JP, Wang Y, Smith GL, Masoudi FA, Foody JM, et al. Anemia and outcomes in patients with heart failure. Arch Intern Med. 2005;165(19):2237.

    Article  PubMed  Google Scholar 

  39. Caughey MC, Avery CL, Ni H, Solomon SD, Matsushita K, Wruck LM et al. Outcomes of patients with anemia and acute decompensated heart failure with preserved versus reduced ejection fraction (from the ARIC study community surveillance). Am J Cardiol. 2014;114(12):1850–4. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.amjcard.2014.09.024

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Acknowledgements

The authors thank the staff and study participants for their important contributions.

Funding

The authors received no specific funding for this study.

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Authors and Affiliations

  1. Département of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia

    Elsah Tegene, Abdulkadir Mohammed, Tamirat Godebo & Gaddisa Desu

  2. School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia

    Edosa Tadasa

Authors
  1. Elsah Tegene
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  2. Abdulkadir Mohammed
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  3. Tamirat Godebo
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  4. Gaddisa Desu
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  5. Edosa Tadasa
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Contributions

E.T: - study design, sampling, writing, reviewing. A.M: - data collection, writing. T.G: - patient recruitment, sampling. G.D: - writing, reviewing. E.T.T: - Data analysis, supervision, writing.

Corresponding author

Correspondence to Edosa Tadasa.

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Ethics approval

Ethical approval for this study was obtained from Jimma University Institute of Health’s Institutional Review Board, Ref. No: JUIH/IRB/042/24.

Competing interests

The authors declare no competing interests.

Informed consent

Written informed consent was obtained from all subjects before the study.

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Tegene, E., Mohammed, A., Godebo, T. et al. Prevalence of anemia and associated factors in patients with heart failure admitted to Jimma university medical center. BMC Cardiovasc Disord 25, 253 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04714-8

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04714-8

Keywords

BMC Cardiovascular Disorders

ISSN: 1471-2261

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