The Association Between Anemia and Heart Failure

There is a strong link between anemia and heart failure. Anemia is a condition in which your body does not have enough healthy red blood cells to carry oxygen to your organs, while heart failure happens when the heart is unable to adequately pump oxygenated blood out to the body. Some congestive heart failure (CHF) patients also have anemia.

You can slow the progression of heart failure if it is diagnosed and treated early. Anemia can be treated, but first, its cause must be diagnosed. In this article, you will learn about how these two conditions are connected.

What Are the Causes of Anemia?

Anemia lowers the number of red blood cells in your blood. There can be several reasons for this. Your body may not be making enough hemoglobin (a protein in your red blood cells) or red blood cells, your body is breaking down red blood cells too fast, or you may have a hemoglobin abnormality. This results in your organs not getting enough oxygen to function properly.

There are a few types of anemia, but the two most common are iron-deficiency anemia and sickle cell disease:

  • Iron-deficiency anemia usually occurs due to blood loss or poor absorption of iron. Menstruation can cause iron loss from heavy bleeding. Pregnancy increases the body’s need for iron.
  • Sickle cell anemia is a genetic condition in which red blood cells are stiff and hook-shaped, making it difficult for blood to move freely through your blood vessels.


Anemia lowers the number of red blood cells in your body. Causes include a hemoglobin abnormality or your body's not making enough red blood cells or it's breaking down red blood cells too fast. The two most common conditions that cause anemia are iron-deficiency anemia and sickle cell disease.

What Is the Association Between Anemia and Heart Failure?

When heart failure happens, fluid gets trapped in the lungs. Fluid also gets backed up in the feet and legs, causing swelling, or edema.

Because your heart can’t pump enough blood around your body, your organs don’t get enough oxygen. As a result, one complication of heart failure is chronic kidney disease (CKD). In this condition, the blood vessels in the kidneys are damaged. The kidneys can’t get enough oxygen, making it difficult for them to filter blood.

CKD also lowers the amount of erythropoietin (EPO) the kidneys make. EPO is a type of protein that helps make red blood cells. Low levels of EPO can cause anemia.

Symptoms to Look For

Anemia vs. Heart Failure Symptoms

Verywell / Jessica Olah

Anemia and heart failure share some common symptoms. They include fatigue, shortness of breath, and a fast heartbeat at rest.

Additional symptoms for anemia are:

Additional symptoms for heart failure include:

  • Swelling in your ankles or legs
  • Dry, hacking cough
  • The urge to urinate more at night or while resting
  • Upset stomach, nausea, or feeling bloated


Shortness of breath, fatigue, and fast heartbeat are all symptoms of both anemia and heart failure. However, with anemia, you may also feel dizziness, easily bruised skin, and restless legs syndrome. With heart failure, you will experience swelling in the legs, a dry cough, and an upset stomach.

Diagnosis and Treatment of Anemia and Heart Failure

Diagnosing heart failure and anemia involves blood tests, imaging, and other medical procedures.


Your doctor will order a complete blood count (CBC) and sometimes a urine test. The blood test will show the number and shape of your blood cells. It can also show if you have low levels of vitamins B12, B9, and iron. The urine test will check for abnormal levels of hemoglobin.

Additional tests may include:

  • Colonoscopy: In this procedure, a long, flexible tube with a camera is inserted into the rectum to look for abnormalities in the large intestine.
  • Bone marrow biopsy: Depending on the results of other tests, your doctor may perform a bone marrow biopsy, which removes tissue to be examined in a lab, to check for conditions like cancer or bone marrow disease.

Treatment for anemia will depend on what is causing it. In some cases, it can be cured. No matter the cause, your doctor will recommend a diet high in iron-rich foods. You’ll also need to avoid foods that prevent your body from absorbing iron.

For iron-deficiency anemia, medical treatment may include iron supplements, iron infusions (iron given intravenously, through an IV), or blood transfusions. If CDK is the cause, EPO infusions may be recommended.

If internal bleeding is the cause of your anemia, you’ll need surgery. An ulcer is likely to cause bleeding. If you have hiatal hernia, in which part of the stomach pushes up through the diaphragm muscle, you are more prone to developing an ulcer and therefore internal bleeding. Sickle cell anemia may require a bone marrow transplant.

Heart Failure

Your doctor may order tests for anemia and high cholesterol, such as a lipid panel. A blood test will also check for levels of a molecule called NT-pro BNP. High levels of NT-pro BNP mean that the chambers of your heart are strained, which is a sign of heart failure.

Other tests your doctor may order include:

Heart Failure Doctor Discussion Guide

Doctor Discussion Guide Old Man

Heart failure can’t be cured, but you can prevent it from getting worse. Treatment will depend on what stage of heart failure you are in and what caused it. Most treatment plans will include medications and lifestyle changes.


Diagnosing heart failure and anemia involves blood tests, imaging, or other kinds of medical procedures. Treating anemia could include iron supplementation, iron infusions, a diet high in iron-rich foods, or surgery. In some cases, the anemia will go away. For heart failure, treatment will focus on preventing the condition from getting worse.

Ways to Prevent Anemia and Heart Failure

Anemia caused by an iron, B12, or B9 deficiency can be prevented by eating more foods rich in those vitamins and minerals. In addition, vitamin C helps your body better absorb those vitamins. However, anemia that is inherited (a gene passed down from a parent) can't be prevented.

You can prevent heart failure by avoiding heart disease. Some risk factors for heart disease are unavoidable. These include older age, sex, race/ethnicity, and family history. Health conditions, like diabetes, can also put you at higher risk for heart disease.

Some ways to lower your risk for heart disease include:

  • Controlling your blood pressure
  • Managing your diabetes
  • Lowering your cholesterol
  • Maintaining a healthy weight
  • Exercising regularly
  • Quitting smoking
  • Not drinking too much alcohol


Anemia caused by a vitamin deficiency can be prevented with diet. Anemia that is inherited, such as sickle cell anemia, can’t be prevented. Heart failure can be prevented by lowering your risk for heart disease. It can help to eat well, not smoke, exercise regularly, and keep a healthy weight. 


You can cure and prevent anemia caused by vitamin deficiency by eating a diet high in iron, B12, and B9, or vitamin supplementation. Some symptoms of anemia can be cured with surgery if the cause is internal, like an ulcer. You can't prevent anemia that is inherited, such as sickle cell anemia.

Heart failure can be prevented by lowering your risk for heart disease. This means exercising regularly, eating healthy foods, and managing chronic health conditions, like diabetes or high blood pressure.

A Word From Verywell

Heart failure and anemia are serious conditions. But if you are diagnosed early, you can successfully manage both conditions. Heart failure is a chronic condition that can't be cured, but you can still live a full and active life. In most cases, anemia can be cured. If you have heart failure and anemia, following your doctor's treatment plan will give you the best chance to have a high quality of life.

Frequently Asked Questions

  • What do severe anemia and heart failure feel like?

    With severe anemia, you may get headaches, have a fast heartbeat, and feel generally weak all the time. As heart failure gets worse, you will have shortness of breath, swelling in your ankles and feet, and a dry cough that happens more when you lay down.

  • When should you seek professional help for anemia and heart failure symptoms?

    With heart failure, don't wait until symptoms become so severe that you need to go to the emergency room. Call your doctor if you have sudden swelling in your legs, an unexplained change in weight, coughing at night, or shortness of breath. For anemia, if you feel weak all the time and have headaches or dizziness that don't go away, call your doctor.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Anemia.

  2. Cleveland Clinic. Heart failure: Understanding heart failure.

  3. MedlinePlus. Heart failure.

  4. American Heart Association. Warning signs of heart failure.

  5. Silverberg DS, Wexler D, Iaina A. The role of anemia in the progression of congestive heart failure. Is there a place for erythropoietin and intravenous iron? J Nephrol. 2004;17(6):749-761. PMID: 15593047

  6. MedlinePlus. Hemolytic anemia.

  7. MedlinePlus. How to prevent heart disease.

  8. Cleveland Clinic. Heart failure: When to call your doctor or nurse about symptoms.

By Carisa Brewster
Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. She specializes in science and healthcare content.