Is “Normal” Hemoglobin Really Normal in Heart Failure? | JACC Baran

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD, welcome Misato Chimura, MD, PhD (University of Glasgow) to discuss her ESC SimPub paper in JACC, “Low-normal hemoglobin concentrations and clinical outcomes in heart failure.” Using individual participant-level data from 11 randomized trials including 42,213 patients across the full LVEF spectrum, the study examined the continuous relationship between hemoglobin and clinical outcomes. Risk was lowest around 14 g/dL in women and 15 g/dL in men, while even patients just above the WHO anemia threshold had higher event rates. The episode explores why “normal” may not always mean low risk in heart failure, the role of iron deficiency, how these findings should and should not influence clinical practice, and the research environment behind the study at the University of Glasgow.