3.2 Effect of red blood cell transfusion on outcomes

3.2.3 Heart failure

Evidence Statements for Acute coronary syndrome
Evidence Statements –
heart failure
Evidence Consistency Clinical impact Generalisability Applicability
ES2.7 In patients with heart failure, the effect of RBC transfusion on the risk of mortality is uncertain. NA NA

ES, evidence statement; RBC, red blood cell

=B; =C; NA,not applicable (see Table 2.1)

Practice Points – heart failure
PP7 In all patients with heart failure, there is an increased risk of transfusion-associated circulatory overload. This needs to be considered in all transfusion decisions. Where indicated, transfusion should be of a single unit of RBC followed by reassessment of clinical efficacy and fluid status. For further guidance on how to manage patients with heart failure, refer to general medical or ACS sections, as appropriate (R1, R3, PP3–PP6).

ACS, acute coronary syndrome; PP, practice point; R, recommendation; RBC, red blood cell

In patients with heart failure, the results of one fair-quality prospective cohort study (Level III-2)89 showed that RBC transfusion was significantly associated with a reduction in 30-day mortality and may be associated with reduced in-hospital mortality. However, because of the low level of evidence, this relationship remains uncertain.

In the absence of strong evidence, guidance relating to transfusion policies in this patient group can be found in the practice point made by the CRG, and extrapolated from experience in other patient populations.

Because of the risk of circulatory overload, patients with heart failure should be transfused with caution, with clinical assessment between each transfused unit.