Supplementary file 1_Burden and clinical impact of anemia in heart failure: insights from a large observational cohort in Saudi Arabia.docx

BackgroundAnemia is a common comorbidity in heart failure (HF) and is associated with adverse outcomes, yet contemporary real-world data describing its burden and relationship with biomarkers of HF severity remain limited.
ObjectivesTo evaluate the prevalence and severity of anemia in patients with HF, identify independent predictors, and examine the association between hemoglobin levels and B-type natriuretic peptide (BNP).
MethodsWe conducted a multicenter retrospective cohort study of adult patients with HF across National Guard Health Affairs hospitals in Saudi Arabia. Anemia was categorized as mild, moderate, or severe based on hemoglobin levels. Clinical characteristics, laboratory parameters, and outcomes were compared by anemia status and severity. Multivariable logistic regression identified independent predictors of anemia. Correlation and linear regression analyses assessed the relationship between hemoglobin and BNP, adjusting for age, sex, chronic kidney disease (CKD), and estimated glomerular filtration rate (eGFR).
ResultsAmong 2,144 patients (median age 67 years; 50.8% female), anemia was present in 56.4% (95% CI 54.3%–58.5%), with moderate anemia most common (53.2%). Increasing anemia severity was associated with older age, longer HF duration, higher prevalence of CKD and atrial fibrillation, worsening renal function, hypoalbuminemia, and progressively higher BNP and troponin levels (all p < 0.001). Cardiovascular mortality increased stepwise, reaching 20.0% in severe anemia. CKD (adjusted OR 2.11, 95% CI 1.32–3.38), lower eGFR, lower albumin, and higher BNP were independently associated with anemia, whereas sodium–glucose cotransporter-2 inhibitor use was associated with lower odds. Hemoglobin showed a moderate inverse correlation with BNP (ρ = −0.409).
ConclusionAnemia is highly prevalent in HF and closely linked to disease severity, adverse clinical profiles, and increased cardiovascular mortality, supporting routine anemia assessment in comprehensive HF care.