What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease, heart failure with reduced ejection fraction, and chronic kidney disease (n=128). Intervention: Higher baseline hemoglobin. Primary outcome: All-cause and cardiovascular mortality (HR 0.864, 95% CI 0.753-0.992).

November 25, 2025Open Access

Higher hemoglobin is associated with better survival in coronary artery disease, heart failure with reduced ejection fraction, and chronic kidney disease

Key Result

Higher baseline hemoglobin was associated with lower all-cause mortality in patients with CAD, HFrEF, and CKD (HR 0.864; 95% CI 0.753-0.992 per 1 g/dl increase).

Study Design

Type

Cohort (n=128)

Multicenter

Structured PICO

Is higher baseline hemoglobin associated with lower mortality in patients with CAD, HFrEF, and CKD?

Population

128 subjects with coronary artery disease (CAD), heart failure with reduced ejection fraction (HFrEF), and chronic kidney disease (CKD)

Intervention

Higher baseline hemoglobin

Outcome

All-cause and cardiovascular mortalityhard clinical

In patients with the complex triple-comorbidity of CAD, HFrEF, and CKD, higher baseline hemoglobin is associated with improved survival.

Main Result

Effect estimate: HR 0.864 (95% CI 0.753-0.992)

Abstract

Background: Anemia is a common comorbidity in patients with heart failure (HF) or chronic kidney disease (CKD) and could be associated with worse clinical outcomes. However, to date, the impact of anemia on survival in a complex triple-comorbidity of coronary artery disease (CAD), HF with reduced ejection fraction (HFrEF), and CKD remains inconclusive. Methods: ) from our cardiac catheterization laboratory between January 2010 and September 2019. Clinical and laboratory variables were recorded from traceable chart records from our hospital. All-cause and cardiovascular mortality were counted until December 2019 and served as study outcomes. Results: A total of 128 subjects with CAD, HFrEF and CKD were analyzed. Anemia was prevalent (81/128 = 63.3 %) in this complex disease combination. The median follow-up duration was 36 months and 77 subjects (60.1 %) died. Cox survival analysis revealed that higher baseline hemoglobin (hazard ratio 0.864, 95 % CI 0.753-0.992, per 1 g/dl increase), higher eGFR, better EF, and the use of beta-blockers were associated with lower all-cause mortality. Conclusions: A higher baseline admission hemoglobin value was associated with lower all-cause mortality in subjects with significant CAD, HFrEF, and CKD.