Anaemia and heart failure: what patients should know

The combination may cause greater tiredness, breathlessness, palpitations or reduced exercise tolerance. Treatment depends on confirming anaemia and finding its cause rather than taking iron without medical advice.

Anaemia means the blood has too little haemoglobin to carry oxygen efficiently. The heart may respond by beating faster and pumping more blood. In someone with heart failure, that extra demand can add to fatigue, breathlessness and fluid-related swelling.

Possible causes include iron deficiency, blood loss, reduced kidney function, poor absorption, vitamin deficiency or chronic inflammation. A blood count can confirm anaemia, while further blood tests and a review of medicines, diet and bleeding symptoms help identify why it developed.

Arrange a clinical review if your energy, breathing or usual walking ability has declined. Record new symptoms, ankle swelling, changes in weight, dark stools, visible bleeding and any missed medicines. Bring your full medicine and supplement list.

Continue prescribed heart-failure treatment unless a clinician advises a change. Do not start iron tablets solely because you feel tired; excess iron can be harmful, and tablets will not correct every form of anaemia. Management may involve treating bleeding, replacing a proven deficiency or adjusting care for another underlying condition.

Seek emergency care for severe breathlessness at rest, chest pain, fainting, confusion, blue or grey lips, vomiting blood, or black tar-like stools. Rapidly worsening swelling or inability to lie flat because of breathing difficulty also warrants prompt assessment.

Contact your clinician soon for steadily increasing fatigue, new palpitations, reduced activity tolerance or swelling that is progressing despite taking medicines as directed.

Ask which test confirmed anaemia, whether iron or vitamin levels and kidney function need checking, what might be causing the change, and how treatment fits with your heart-failure medicines. Clarify which symptom changes should trigger an earlier review.