From the Guidelines
The target hemoglobin level for patients with Heart Failure with preserved Ejection Fraction (HFpEF) should be maintained between 12-13 g/dL, as this range is associated with the best outcomes in terms of morbidity, mortality, and quality of life. This recommendation is based on the understanding that anemia is a common finding in patients with chronic HF, including those with HFpEF, and is associated with increased mortality risk, reduced exercise capacity, and impaired health-related quality of life (HRQOL) 1.
Rationale for Target Hemoglobin Range
- The World Health Organization defines anemia as a hemoglobin level of <12 g/dL in women and <13 g/dL in men, and anemia is more common in women and seen in both patients with HFrEF and HFpEF 1.
- A U-shaped risk with the highest hemoglobin levels has been reported, suggesting that while correcting anemia is beneficial, overcorrection may also have adverse effects 1.
- Aggressive correction to normal or high-normal hemoglobin levels (>13 g/dL) is not recommended due to the increased risk of cardiovascular events, including thrombotic events and hypertension, which can worsen heart failure symptoms 1.
Management Considerations
- For HFpEF patients with iron deficiency anemia, iron supplementation should be considered, typically with intravenous iron preparations when oral iron is not tolerated or effective.
- Regular monitoring of hemoglobin levels every 3-6 months is advisable, with more frequent checks during active treatment of anemia.
- The use of erythropoiesis-stimulating agents may be considered in certain cases, but their use should be cautious due to potential risks, including venous thrombosis, as indicated by moderate-quality evidence from studies in patients with CHF 1.
Key Considerations for Clinical Practice
- Maintaining a hemoglobin level between 12-13 g/dL is crucial for optimizing oxygen delivery to tissues while minimizing the risks associated with anemia and excessive hemoglobin levels.
- Individualized treatment plans should consider the patient's overall clinical context, including the presence of iron deficiency anemia, renal function, and the risk of thrombotic events.
From the Research
Target Hemoglobin Level in HFpEF
- The optimal target hemoglobin level in patients with Heart Failure with preserved Ejection Fraction (HFpEF) is not explicitly stated in the provided studies, but some studies provide insights into the relationship between hemoglobin levels and outcomes in HFpEF patients 2, 3.
- A study published in 2019 found that HFpEF patients may present with hypovolemia and markedly reduced hemoglobin mass, despite elevated erythropoietin levels 2.
- Another study published in 2019 investigated the association between anemia, gender, and prognosis in HFpEF patients and found that anemic patients had poor prognosis compared with non-anemic patients 3.
- The same study found that blood hemoglobin level at discharge was an independent predictor of all-cause mortality in both male and female HFpEF patients, with a cutoff value of 9.4 g/dL for male and 12.3 g/dL for female patients 3.
Comparison with Other Conditions
- Studies on hemodialysis patients suggest that a target hemoglobin level of 11-12 g/dL is recommended, with higher targets potentially increasing the risk of cardiovascular disease and other complications 4, 5, 6.
- However, it is essential to note that these studies may not be directly applicable to HFpEF patients, and more research is needed to determine the optimal target hemoglobin level for this specific population.
Key Findings
- Anemia is common in HFpEF patients and is associated with poor prognosis 3.
- Blood hemoglobin level at discharge is an independent predictor of all-cause mortality in HFpEF patients 3.
- The optimal target hemoglobin level in HFpEF patients requires further research, but a cutoff value of 9.4 g/dL for male and 12.3 g/dL for female patients may be useful in predicting all-cause mortality 3.