We investigated the association between anemia status and the risk of heart failure (HF) in patients with coronary heart disease (CHD) based on a multi-center, large-sample and retrospective cross-sectional study including 89,207 patients. Heart failure was categorized as HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and HF with mid-range ejection fraction (HFmrEF). In multi-adjusted models, compared with patients without anemia, mild anemia (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.53–1.91; P < .001), moderate anemia (OR 3.68; 95% CI, 3.25–4.17; P < .001), and severe anemia (OR 8.02; 95% CI, 6.50–9.88; P < .001) were associated with the risk of HF among CHD patients. Men aged <65 years were more likely to develop HF. In subgroup analyses, the multi-adjusted ORs and 95% CI of HFpEF, HFrEF, and HFmrEF related to anemia were 3.24 (95% CI 1.43–7.33), 2.22 (95% CI 1.28–3.84), and 2.55 (95% CI 2.24–2.89), respectively. These findings suggest that anemia might be associated with increased risk of different types of HF, especially HFpEF.
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