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Anemia is a common comorbidity in patients with chronic heart failure. Compared to the general population, the prevalence of anemia is much higher among heart failure patients and is increasing with severity of the disease. Anemia therefore represents a strong independent

prognostic factor of adverse outcome in these patients. Although recent data suggests that anemia in heart failure may be related to the activation of inflammatory response, the evi­dence is inconclusive. The aim of our study was to better define the patophysiologic background and prognostic factors in patients with heart failure and anemia, and to investigate the role of inflammatory response activation in this regard. A total of 95 patients with chronic heart failure and anemia defined as hemoglobin levels below 120 g/l were enrolled in this prospec­tive study. Based on a standard questionnaire, data on morbidity and mortality were collected over a one-year period, including information on survival times and causes of death in patients who died in that period. Patients who died within 1 year had significantly lower hemoglobin levels compared to those who survived (p < 0.05). Contrary to our hypothesis, however, inflam­matory activation was not associated with worse 1-year survival, and higher levels of CRP were not associated with lower hemoglobin levels. However, 1-year survival in our patient cohort was significantly affected by the presence of renal insufficiency (76% of patients with renal insufficiency among the expired vs. 41% in the remaining cohort, p < 0.05). Similarly, diabetes mellitus was more frequent among the expired patients than in those who survived (p < 0.05). Patients who died were older (p<0.05), but there was no difference in their gender struc­ture compared to those who survived. In the multivariate analysis, renal insufficiency and diabetes mellitus were found to be the only independent predictors of outcome in our patient cohort (p < 0.05). Lower hemoglobin levels are associated with a higher mortality rate in patients with chronic heart failure. Inflammatory response activation does not have adverse effects on patients with chronic heart failure and anemia and is not associated with lower hemoglobin levels in these patients. Renal insufficiency and diabetes mellitus are important independent predic­tors of adverse outcome in patients with chronic heart failure and anemia. Female gender and ACE inhibitor therapy do not affect the prognosis of patients with chronic heart failure and anemia and are not associated with lower hemoglobin levels in these patients.