Health-related quality of life in outpatients with chronic heart failure associated with sideropenic anemia

  • Biljana Djukic
  • Maja Racic
  • Biljana Mijovic
  • Nedeljka Ivkovic
Original Article



The aim of this study was to assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in outpatients with chronic congestive heart failure.


The data were collected from patients with chronic congestive heart failure admitted to a university hospital outpatient clinic who agreed to be involved in the cross-sectional study. According to the World Health Organization’s cutoffs to define anemia, the patients were further divided into two groups, with and without anemia. HrQoL was assessed using two questionnaires: a disease-specific instrument, the chronic heart failure questionnaire (CHFQ), and a generic instrument, the Sickness Impact Profile (SIP). The standardized questionnaire was used to collect data regarding patients’ gender, age, marital status, place of living, education, occupation, and duration of diseases and comorbidities. To assess the iron status, ferritin, serum iron, the total iron binding capacity/TIBC and transferrin were measured.


In total, 200 outpatients with congestive heart failure were included in the study, 100 with and 100 without anemia. Patients with anemia were mainly female, had longer duration of disease (p = 0.001) and more hospitalizations (p = 0.001). Independent associations were found between the HrQoL and hemoglobin level (p = 0.049), HrQoL and hematocrit value (p = 0.006) and HrQoL and NYHA functional class (p = 0.004). Iron deficiency was not associated with impaired HrQoL.


Anemia has a significant impact on self-perceived health. Anemic patients are more likely to have worse heart failure as indicated by a higher NYHA class, thus being at higher risk for a decline of HrQoL compared with non-anemic patients.


Anemia Quality of life Heart failure Chronic disease Outpatients 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest. The authors are responsible for the content and writing of the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Primary Health Care Center Banja LukaBanja LukaBosnia and Herzegovina
  2. 2.Department for Primary Health Care and Public Health, Faculty of MedicineUniversity of East SarajevoFocaBosnia and Herzegovina
  3. 3.Department for Oral Rehabilitation, Faculty of MedicineUniversity of East SarajevoFocaBosnia and Herzegovina

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