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Haemoglobin level is inversely related to LVEF, and an increase in haemoglobin over time is associated with a decrease in LVEF.148 Defective iron usage, inappropriate erythropoietin production, and depressed bone marrow function due to renal dysfunction and neurohormonal and proinflammatory cytokine activation leading to increased myocardial workload are suggested causes of anaemia in HF.149 In a post-hoc analysis of the TOPCAT-Americas population, the risk of mortality and HF-hospitalisations increased significantly with a decrease in haemoglobin after extensive adjustment

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