Association between nutritional deficiency anemia and clinical outcomes in patients with heart failure: a multi-institutional population-based Study

Nutritional deficiencies have been increasingly recognized as potential contributors to adverse cardiovascular outcomes. However, their relationship with clinical outcomes in patients with heart failure (HF) remains unclear. This study aimed to evaluate the association between nutritional deficiency anemia (NDA) and clinical outcomes in patients with HF. We conducted a retrospective cohort study, identifying 1,558,577 adult patients diagnosed with HF. Among these, 86,186 patients were classified as having NDA. A 1:1 propensity score matching (PSM) was performed, resulting in 86,181 matched pairs. The primary outcome was a composite of all-cause mortality, HF exacerbation (HFE), and major adverse cardiovascular events (MACE). Secondary outcomes included individual components of the composite outcome. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. The composite outcome occurred more frequently in the NDA group than in the control group (HR: 1.414, 95% CI: 1.38–1.449, p < 0.0001). Secondary outcomes further demonstrated an increased risk of all-cause mortality (HR: 1.484, 95% CI: 1.432–1.539), HFE (HR: 1.440, 95% CI: 1.396–1.486), and MACE (HR: 1.278, 95% CI: 1.22–1.338), all with p < 0.0001. NDA was associated with worse clinical outcomes in patients with HF, including increased risks of all-cause mortality, HFE, and MACE. These findings suggest that coded nutritional deficiency anemia may represent a clinically relevant prognostic marker in HF populations. Further studies are warranted to clarify the underlying mechanisms and clinical implications of this association.