Red blood cell metrics as predictors of cardiovascular risk in anemic versus non-anemic heart failure patients

Chronic heart failure is a growing health concern globally, with rising prevalence and considerable social and economic impact as a leading cause of death. Although significant progress has been made in cardiovascular disease treatment over the last two decades, this condition continues to pose a significant clinical challenge. The connection between red blood cell parameters and major cardiovascular complications in patients with chronic heart failure remains poorly understood. Assessing these metrics could enhance our ability to predict long-term cardiovascular outcomes in this patient population. In this single-center, retrospective analysis of a prospective cohort, 419 chronic HF patients (mean age 63.70 ± 11.67 years) were enrolled between 2023 and 2024 and categorized into anemic (n = 251) and non-anemic (n = 168) groups based on WHO hemoglobin criteria. Baseline demographic, clinical, and hematological parameters (MCV, MCH, MCHC, RDW, Hb, HCT) were recorded. Patients were monitored over 12 months for major adverse cardiovascular events, encompassing cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, or cardiac rehospitalization. Statistical analysis was conducted using SPSS version 16, with significance defined as p < 0.05. Anemic patients had a higher prevalence of diabetes, hyperlipidemia, prior CABG, and smoking (all p < 0.05). They also exhibited significantly lower MCH, MCHC, Hb, and HCT, and higher RDW (p < 0.05). Correlation analyses revealed significant associations between various RBC indices and hematological parameters in both groups. However, in the multivariable analysis, none of the RBC indices including hemoglobin, hematocrit, MCH, and MCHC were independent predictors of rehospitalization or all-cause mortality (all p > 0.05). Hyperlipidemia showed a non-significant trend toward increased all-cause mortality (OR: 1.675; 95% CI: 0.954–2.942; p = 0.073). Although anemia and aberrant red blood cell indices correlate with an unfavorable clinical profile in heart failure patients, they did not independently predict short-term major adverse cardiovascular events in this study population. This implies that the prognostic significance of these standard hematologic parameters may be constrained in advanced heart failure.