In this study the authors assessed the prevalence and clinical correlates of CRAS in systolic heart failure and the relationship between renal dysfunction and anaemia on hard clinical outcomes. In the 951 patients with CHF and systolic dysfunction assessed the prevalence of CRAS was 21.1%. Age, body mass index, diabetes, ischaemic aetiology, LVEF and treatment with renin-angiotensin system inhibitors were independently related to CRAS. During a median follow-up of 3.7 years, the primary outcome of all-cause mortality or urgent heart transplantation occurred in 404 patients (42.5%). Importantly, compared with patients with preserved renal function and normal Hb levels, those with CRAS had a significantly increased risk for the primary outcome – in fact 3-year urgent heart transplantation-free survival was 86% in patients with preserved renal function and normal Hb compared with only 47% in those with CRAS. Among patients with renal dysfunction, the adjusted HR for the primary outcome increased by 17% for each 1 g/dL decrease below a Hb value of 13.0 g/dL.

The authors conclude that despite a relatively low prevalence, CRAS contributes to considerable mortality due to CHF.

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