Prevalence of Anemia, Its Associated Factors, and Impact on Quality of Life Among Heart Failure with Reduced Ejection Fraction Outpatients at the University of Gondar Hospital, Ethiopia

Prevalence of Anemia, Its Associated Factors, and Impact on Quality of Life Among Heart Failure with Reduced Ejection Fraction Outpatients at the University of Gondar Hospital, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Anemia, Its Associated Factors, and Impact on Quality of Life Among Heart Failure with Reduced Ejection Fraction Outpatients at the University of Gondar Hospital, Ethiopia Daniel Belay Agonafir, Biruk Mulat Worku, Hailemaryam Alemu, Andinet Azaje Alemu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6856747/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jul, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract Background Anemia is a frequent comorbidity in patients with heart failure and is associated with increased morbidity, mortality, and reduced quality of life. However, data on anemia prevalence, associated factors, and its prognostic significance are limited in our region. This study aimed to determine the prevalence of anemia in outpatients with heart failure with reduced ejection fraction, identify contributing factors, and evaluate its impact on quality of life at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted using an interviewer-administered questionnaire. Data collected included demographic, lifestyle, clinical, biochemical, and echocardiographic characteristics. Health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. Data were entered into EpiData 4.6 and analyzed using STATA 25. Bivariable and multivariable binary logistic regression analyses were performed to identify factors associated with anemia. Variables with a p-value ≤ 0.05 in the multivariable analysis (based on AORs with 95% CIs) were considered statistically significant. Results Among 226 participants (mean age 51.12 ± 13.17 years), the prevalence of anemia in heart failure with reduced ejection fraction patients was 44.2% (95% CI: 37.7–51.0). Anemia was significantly associated with Age ≥ 50 years: AOR 4.18 (95% CI: 1.65–10.58), Hypotension: AOR 3.96 (95% CI: 1.33–11.75), HF duration ≥ 1 year: AOR 4.60 (95% CI: 1.76–11.97), Recent hospitalization: AOR 3.31 (95% CI: 1.42–7.67), Presence of comorbidities: AOR 6.36 (95% CI: 2.28–17.76), Severely reduced ejection fraction: AOR 3.12 (95% CI: 1.29–7.52), and Poor quality of life: AOR 10.52 (95% CI: 3.9–28.36). Conclusion Anemia is highly prevalent among heart failure with reduced ejection fraction patients in this study and strongly associated with factors indicating advanced disease and comorbidity burden. Importantly, anemia is a significant predictor of poor Health-related quality of life. These findings highlight the need to recognize anemia as a key determinant of morbidity and reduced well-being in HFrEF patients. Anemia quality of life heart failure reduced ejection fraction Ethiopia Figures Figure 1 Background Heart Failure (HF) is a complex and life-threatening condition that significantly impacts morbidity, mortality, functional ability, quality of life, and healthcare costs ( 1 ). As a global public health concern, it affects an estimated 64.3 million people worldwide, with roughly half of the cases classified as Heart Failure with Reduced Ejection Fraction (HFrEF)( 2 , 3 ). In Sub-Saharan Africa, HF remains a major health challenge and is among the top five leading causes of death in Ethiopia( 4 ). Anemia is a frequent comorbidity in heart failure patients, particularly those with HFrEF, with studies suggesting that over one-third of HFrEF patients are affected. The reported prevalence of anaemia in this population varies significantly depending on factors such as patient demographics, the diagnostic criteria used, HF severity, and the presence of additional comorbidities ( 5 – 9 ). Notably, prevalence can reach up to 50% in hospitalized patients with acute heart failure decompensation ( 10 ). The development of anaemia in HF patients stems from a complex interplay of factors, including chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, micronutrient deficiencies, and conditions causing blood loss ( 5 , 11 ). The predominant form is anaemia of chronic disease, driven by renal dysfunction, impaired erythropoiesis, reduced erythropoietin (EPO) responsiveness, and systemic inflammation. Additionally, plasma volume expansion and hemodilution may contribute to pseudoanaemia. Certain medications, such as angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), have also been associated with anaemia due to their suppression of EPO synthesis and bone marrow activity. While deficiencies in iron, folate, and vitamin B12 play a role, iron deficiency accounts for a significant proportion of cases ( 5 , 9 , 11 , 12 ). Independent risk factors for anaemia in HF include male sex, advanced age, higher NYHA functional class, lower systolic blood pressure, CKD, diabetes, ischemic aetiology, and the use of diuretics and ACEIs/ARBs ( 13 – 15 ). Anaemia in HF is associated with increased hospitalization rates, higher morbidity and mortality, and diminished quality of life (QoL) ( 8 , 16 ). The correlation between anemia and QoL can be attributed to several factors. Anemia often leads to increased fatigue, decreased exercise tolerance, and greater difficulty in performing daily activities, thereby negatively impacting the health-related QoL. Additionally, the presence of anemia has been associated with increased symptoms of depression and anxiety in patients with HF, further deteriorating QoL. Early treatment of anemia may therefore enhance both clinical outcomes and overall patient QoL ( 11 , 15 ). Despite its clinical significance, there is limited research on anaemia in HF patients within our region. This study aims to assess the prevalence of anaemia, identify associated factors, and evaluate its impact on quality of life among HFrEF patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia. Methods and materials Study design, setting, and population The study was a cross-sectional, institution-based study conducted from August 2023 to January 2024 at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) in North West Ethiopia. This facility ranks among the largest hospitals in the country, offering health services to approximately 13 million individuals within its catchment area. UoGCSH features several follow-up clinics dedicated to major chronic illnesses, one of which is the Cardiac clinic. Currently, around 3,000 cardiac patients receive ongoing care at this specialized clinic. The source population comprised all adult patients diagnosed with HFrEF who were under chronic follow-up at the UoGCSH. The study population included all adult patients with HFrEF who attended the chronic follow-up clinic at UoGCSH throughout the defined study period. Inclusion and exclusion criteria Adult patients aged 18 years and older diagnosed with HFrEF who had received follow-up care at the cardiac clinic of the UoGCSH for a minimum duration of three months were included in this study. Exclusion criteria comprised Patients with cognitive impairments (e.g., dementia, psychosis) affecting recall ability. Those with acute concurrent conditions (e.g., acute heart failure exacerbations, severe infections) that could substantially alter quality of life. Pregnant women and patients receiving iron supplementation or blood transfusions. Sample size and sampling procedure The sample size was calculated using Epi Info, based on an 82% prevalence from a prior study in Nepal (17), a 95% confidence interval, and a 5% marginal error. Adding a 10% non-response rate, the total sample size was 232. A consecutive sampling technique was utilized, enrolling all eligible patients until the target sample size was reached. Data collection tools and procedures Data were collected using structured questionnaires, covering: Sociodemographic, lifestyle, clinical, biochemical, and echocardiographic variables. Health-Related Quality of Life (HRQoL), assessed via the Minnesota Living with Heart Failure Questionnaire (MLHFQ)—a globally validated tool for HF patients (18, 19). The MLHFQ was translated into Amharic (local language) and back-translated to English to ensure consistency. Clinical, biochemical, and echocardiographic data were extracted from medical records. For lab parameters (hemoglobin, serum creatinine, serum sodium), three-month averages prior to the visit were used. Analyses were performed using Yumizen H550 (hematology) and AU480 (chemistry) automated analyzers. Sociodemographic and MLHFQ data were obtained through face-to-face interviews conducted by two trained cardiac nurses, supervised by a general practitioner. Data quality assurance Training: Data collectors and supervisors received instruction on protocols, study objectives, and confidentiality. Pretesting: A pilot test with 20 participants evaluated questionnaire clarity, language appropriateness, and reliability. Daily monitoring: The principal investigator and supervisor reviewed data for accuracy and completeness throughout the collection phase. This study shared methodological similarities with a prior study conducted in the same setting (20), particularly in terms of design, duration, study population, and data collection tools and procedures. However, it differed in its inclusion/exclusion criteria and had distinct study objectives. Study variables Dependent variable Anemia Independent variables Demographic Factors: Age, gender, place of residence, marital status, educational attainment, occupation, and income level. Lifestyle Factors: Current smoking habits, alcohol consumption, and dietary salt intake. Clinical Factors: Vital signs: Systolic blood pressure (SBP), heart rate (HR). HF characteristics: Duration of HF, etiology (ischemic heart disease [IHD], dilated cardiomyopathy [DCMP], chronic rheumatic valve disease [CRVHD], degenerative valvular heart disease [DVHD], others). Disease severity: NYHA functional class (I–IV), recent hospitalization (past 6 months). Comorbidities: Atrial fibrillation, hypertension, obesity, dyslipidemia, diabetes mellitus (DM), chronic kidney disease (CKD), etc. Medications: Diuretics, beta-blockers, ACEIs/ARBs, spironolactone, digoxin, antiplatelets, anticoagulants, statins, etc. Biochemical Factors: Hemoglobin, Serum creatinine, Serum sodium (averaged from results obtained over the past three months). Echocardiographic Factors: Left ventricular ejection fraction (LVEF) and pulmonary hypertension (PH) severity at HF diagnosis. Health related quality of life: assessed by Minnesota Living with Heart Failure Questionnaire. Operational definitions Anemia Anemia was defined according to World Health Organization (WHO) criteria as hemoglobin levels below 12 g/dL for non-pregnant women and below 13 g/dL for men. The WHO further classifies anemia severity as follows. In men: Mild anemia (11–12.9 g/dL), Moderate anemia (8–10.9 g/dL) and Severe anemia (< 8 g/dL). In non-pregnant women: Mild anemia (11–11.9 g/dL), Moderate anemia (8–10.9 g/dL) and Severe anemia (< 8 g/dL)(21). Heart failure with reduced ejection fraction patients Defined as HF patients with an echocardiographically confirmed LVEF ≤40%. Health-related quality of life Health-related quality of life in patients with HF is an important patient-reported health status measure that evaluates the impact of HF and its medical interventions on various domains of life. It is evaluated using the MLHFQ, which consists of 21 items rated on a 6-point Likert scale (0 = no impact, 5 = severe impact). Total score range: 0–105 (higher scores indicate worse HRQoL). Subscales: Physical domain (items 2–7, 12–13; range 0–40), Emotional domain (items 17–21; range 0–25). Classification: Good HRQoL: 45 (22). New York Heart Association (NYHA) Functional Class Class I: No limitations in physical activity. Class II: Mild limitations (comfortable at rest, but ordinary activity causes symptoms). Class III: Marked limitations (comfortable at rest, but minimal activity triggers symptoms). Class IV: Symptoms at rest; inability to perform any physical activity without discomfort (23). Data processing and analysis The collected data were entered into Epi Data version 4.6 and analyzed using SPSS version 25 after verifying data integrity. A reliability test (Cronbach’s alpha) was performed to assess the consistency of the items in the MLHFQ tool, yielding values of 0.99 for overall HRQoL, 0.98 for the physical domain, and 0.98 for the emotional domain. Descriptive analyses, including frequencies, means, and medians, were conducted. To identify factors associated with anemia, both bivariable and multivariable logistic regression analyses were employed. Variables with p-values <0.25 in the bivariable analysis were included in the multivariable model, and those with p-values ≤0.05 were considered statistically significant. Model fitness was evaluated using the Hosmer-Lemeshow test, which yielded a p-value of 0.4 (>0.05), indicating a good fit. The findings were systematically organized and presented using frequency tables and graphs. Results Demographic and lifestyle characteristics The study included 226 patients with HFrEF under follow-up at a cardiac clinic, achieving a response rate of 97.4%. The majority (52.2%) were over 50 years old, with a mean age of 51.12 ± 13.17 years. Among the participants, 51.3% were female, 50.4% resided in urban areas, and 60.6% were married. Nearly one-third (33.6%) were housewives, while 41.6% had no formal education. Regarding lifestyle factors, 9.7% were current smokers, 33.2% reported high salt intake, and 20.4% were current alcohol drinkers (Table 1). Clinical, biochemical and echocardiographic Characteristics The study participants had a median (IQR) SBP of 105 (20) mmHg (range: 75–150), with 27.4% experiencing hypotension. The median (IQR) HR was 89 (23) bpm (range: 40–112), and 35.8% of patients had tachycardia. The median (IQR) illness duration was 1.5 (1.0) years (range: 6 months–6 years), with 78.3% of patients having HF for over a year. Most participants (53.1%) were classified as NYHA class III or IV, and 45.1% had been hospitalized within the past six months. The primary etiologies of HFrEF identified were IHD (39.8%), CRVHD (24.8%), DCMP (24.3%), and DVHD (11.1%). Among the participants, 58.4% had at least one comorbidity; including atrial fibrillation (24.3%), hypertension (23.5%), dyslipidemia (18.6%), diabetes (11.1%), thyrotoxicosis (9.3%), and obesity (8.8%). Medication use was as follows: ACEIs/ARBs (92%), beta-blockers (76.1%), furosemide (60.6%), antiplatelets (40.7%), statins (36.7%), spironolactone (32.3%), anticoagulants (24.8%), and digoxin (2.7%) (Table 2). This study included the mean values of laboratory results obtained over the past three months. The median (IQR) values were as follows: Hemoglobin (Hg): 13.5 (3.8) g/dL (range: 7–16.9 g/dL), with 34.2% of patients exhibiting low Hg levels. Creatinine (Cr): 0.99 (0.83) mg/dL (range: 0.45–3.3 mg/dL), with 39.8% of patients having elevated Cr. Sodium (Na): 137 (8) mEq/L (range: 120–150 mEq/L), with 35.8% of patients having hyponatremia. Regarding cardiac function: on baseline echocardiography, LVEF was a median (IQR) of 30 (7.25)% (range: 14–40%), with 36.7% of patients having severe systolic dysfunction and 63.3% exhibiting moderate systolic dysfunction. 62.4% had mild or no PH, while 37.6% had moderate or severe PH. (Table 3). Prevalence of Anemia and its impact on Quality of Life Study participants’ chart review was conducted to evaluate the prevalence of anemia among HFrEF patients. Out of 226 HFrEF patients on follow-up at UoGCSH, 100 (44.2%) were found to have anemia. This study confirms an overall anemia prevalence of 44.2% (95% CI: 37.7–51.0) in this patient population. Among anemic HFrEF patients, 45 (45%) of patients had mild anemia, 43 (43%) had moderate anemia and 12 (12%) of patients had severe anemia. In this study, the MLHFQ was used to evaluate HRQoL, revealing mean scores of 17.69 ± 10.46 for physical domain, 10.70 ± 6.34 for emotional domain, and 47.36 ± 47 for total HRQoL. 43.8% of participants were classified as having a poor HRQoL, while 24.8% and 31.4% were assessed as having moderate and good HRQoL, respectively (Table 4). Among anemic HFrEF patients, 82 (82%) of patients had poor HRQoL while 8 (8%) had moderate HRQoL and 10(10%) patients had good HRQoL (Fig 1). Factors associated with Anemia In the Bivariable logistic regression: patient age, sex, smoking and alcohol history, salt intake, SBP, HR, duration of HF, NYHA class, recent hospitalization, comorbidities (hypertension, diabetes mellitus, atrial fibrillation, thyrotoxicosis, dyslipidemia), HF medications (β-blockers, furosemide, antiplatelets, anticoagulants), serum creatinine and sodium levels, baseline echocardiography LVEF, and HRQoL were included as candidate variables for multivariable logistic regression analysis at a significance level of 0.25. In multivariable logistic regression analysis, seven significant predictors of anemia in HFrEF patients were identified. Age ≥50 years: AOR 4.18 (95% CI: 1.65–10.58), Hypotension (SBP<90 mmHg): AOR 3.96 (95% CI: 1.33–11.75), HF duration ≥1 year: AOR 4.60 (95% CI: 1.76–11.97), Recent hospitalization: AOR 3.31 (95% CI: 1.42–7.67), Presence of comorbidities: AOR 6.36 (95% CI: 2.28–17.76), Severely reduced LVEF: AOR 3.12 (95% CI: 1.29–7.52), and Poor HRQoL: AOR 10.52 (95% CI: 3.9–28.36) (Table 5). Discussion This study provides important insights into the burden of anemia, its contributing factors, and its profound impact on the well-being of HFrEF patients. The findings highlight anemia as a highly prevalent and clinically significant comorbidity in this population, intricately linked to both disease severity and patient-reported outcomes. The observed anemia prevalence of 44.2% (95% CI: 37.7–51.0) among HFrEF patients in this study underscores its substantial burden. This rate was comparable to that of general HF patients at Brazzaville University Hospital, Congo (42%)( 24 ) and to Asian patients with HFrEF (41%) ( 15 ). However, our finding is higher than the prevalence of 27% reported in a study from Saudi Arabia and significantly lower than the 82% reported in Nepal ( 17 ). This large variability may be explained by demographic and methodological differences. This elevated prevalence likely reflects a confluence of factors prevalent in this population and setting, including nutritional deficiencies (iron, folate, vitamin B12), a high burden of chronic infections/inflammation (e.g., malaria, helminths, tuberculosis), CKD often associated with HF, and potentially limited access to optimal HF management and anemia diagnostics/treatment prior to presentation. The finding reinforces that anemia is not merely a bystander but a major comorbidity demanding attention in HFrEF care ( 7 , 8 ). The current study identified factors associated with anemia among HFrEF patients. The odds of developing anemia in HFrEF patients aged ≥ 50 years were 4.18 times higher, a finding consistent with previous studies in Asian ( 15 ) and Swedish populations ( 25 ). This strong association aligns with physiological aging processes, including reduced erythropoietin responsiveness, a higher prevalence of comorbidities contributing to anemia (e.g., CKD, occult malignancies), and potential nutritional deficiencies. It underscores the need for heightened vigilance for anemia in older HFrEF patients ( 11 ). In this study, hypotensive HFrEF patients had 3.96 times higher odds of anemia compared to normotensive patients, consistent with studies from Nigeria ( 26 ) and Sweden ( 27 ). Low systolic blood pressure often reflects advanced HF, reduced cardiac output, and consequently, impaired renal perfusion. This can suppress erythropoietin production, directly linking hemodynamic compromise to anemia development ( 5 ). HFrEF patients with a disease duration of ≥ 1 year had 4.6 times higher odds of anemia than those with shorter durations. Longer disease duration signifies greater cumulative exposure to the pathophysiological mechanisms linking HF and anemia, including chronic inflammation, neurohormonal activation (e.g., RAAS overactivity), renal dysfunction, and potentially the effects of long-term loop diuretic use (e.g., iron loss)( 5 , 11 ). HFrEF patients with a recent hospitalization history had 3.31 times higher odds of anemia, mirroring findings in Swedish studies ( 25 ). Hospitalization is a marker of HF instability, disease severity, and acute decompensation. These states exacerbate inflammation, hemodynamic compromise affecting renal function, and nutritional deficiencies, all contributing to or worsening anemia. Anemia itself can also precipitate hospitalization, suggesting a potential bidirectional relationship( 11 ). The prevalence of anemia among HFrEF patients with comorbidities was 6.36 times higher, aligning with studies from Thailand ( 28 ) and Sweden ( 25 ). Comorbidities like CKD (impairing erythropoietin production and iron metabolism), diabetes (associated with anemia of chronic disease and CKD), chronic inflammatory conditions, and occult blood loss significantly amplify anemia risk ( 11 , 29 , 30 ). HFrEF patients with severely reduced LVEF had 3.12 times higher odds of anemia than those with moderate LVEF, consistent with Nigerian data ( 26 ). More severe systolic dysfunction correlates with worse cardiac output, lower renal perfusion, greater neurohormonal activation, and higher levels of inflammatory cytokines, all established pathways contributing to anemia in HF. This links the core pathophysiology of HFrEF directly to anemia risk ( 5 , 11 , 31 ). Finally, anemia prevalence was 10.52 times higher in HFrEF patients with poor HRQoL, matching findings from Nigeria ( 26 ), Iran ( 32 ), Asia ( 15 ). This suggests a profound link between anemia and diminished quality of life. Anemia likely exacerbates fatigue, dyspnea, and exercise intolerance, impairing daily functioning, while poor HRQoL may reflect or worsen HF and anemia severity ( 33 – 35 ). Strengths of the study include its focus on a clinically important comorbidity in an understudied population, the use of adjusted analyses to identify independent predictors, and the inclusion of patient-centered HRQoL outcomes. Limitations include the single-center design, which may limit generalizability; the cross-sectional nature of the study, preventing causal inference; possible residual confounding due to unmeasured variables (e.g., detailed nutritional status, specific comorbidities, medication adherence); and the lack of data on anemia subtypes (e.g., iron deficiency). Conclusion Anemia is highly prevalent (44.2%) among HFrEF patients and is strongly associated with factors indicative of advanced disease and comorbidity burden (older age, hypotension, longer HF duration, recent hospitalization, comorbidities, severely reduced LVEF). Crucially, anemia is independently and very strongly associated with poor Health-Related Quality of Life, affecting the vast majority of anemic patients. These findings underscore the critical importance of recognizing anemia as a key determinant of morbidity and impaired well-being in HFrEF patients. Integrating routine anemia screening, etiological investigation, and management into standard HF care protocols, particularly for high-risk individuals, holds significant potential to alleviate symptoms, improve functional capacity and quality of life, and potentially modify the disease trajectory in this vulnerable population. Future research should focus on longitudinal outcomes and targeted interventions for anemia in this setting. Abbreviations ACEI, Angiotensin converting enzyme inhibitor; ARB, Angiotensin receptor blocker; bbp, beat per minutes; CRVHD, Chronic rheumatic valvular heart disease; CKD, Chronic kidney disease; DCMP, Dilated cardiomyopathy; DM, Diabetes mellitus; DVHD, Degenerative valve heart disease; EPO, Erythropoietin; Hb, Hemoglobin; HF, Heart failure; HFrEF, Heart failure with reduced ejection fraction; HRQoL, Health-Related Quality of Life; HR, Heart rate; IHD, Ischemic heart disease; LVEF, Left ventricular ejection fraction; MLHFQ, Minnesota Living with Heart Failure Questionnaire ; mmHg, Millimetres of mercury, NYHA, New York Heart Association; Pulmonary hypertension, PH; QoL, Quality of life; RAAS, Renin angiotensin aldosterone system; SBP, Systolic blood pressure; UoGCSH, University of Gondar Comprehensive Specialized Hospital Declarations Ethics approval and consent to participate This study received ethical approval from the Ethical Review Board of the School of Medicine, College of Medicine and Health Sciences, University of Gondar (Reference No.: SOM/06/01659/2015; Approval Date: May 18, 2023). Written informed consent was obtained from all participants prior to their inclusion in the study. To ensure participant privacy, all collected information was handled with strict confidentiality. Personally identifiable details, such as names, were not recorded at any stage of the research. Consent for publication Not applicable. Data availability All data generated or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. Funding The authors received no specific funding for this study. Author contributions Conceptualization: DB Data curation: DB Formal Analysis: DB Investigation: DB Methodology: DB, BM, HA, AA, GL Project administration: DB, BM, HA, AA, GL Resources: DB Supervision: DB, BM, HA, AA, GL Visualization: DB, BM, HA, AA, GL Writing – original draft: DB, BM, HA, AA, GL Writing – review & editing: DB, BM, HA, AA, GL. 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Correlation between hemoglobin level and quality of life in male patients with systolic heart failure. Sci J Iran Blood Transfus Organ. 2012;9(2):160–9. Comín-Colet J, Martín Lorenzo T, González-Domínguez A, Oliva J, Jiménez Merino S. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes. 2020;18:1–13. Doehner W, von Haehling S, Anker SD. Anaemia predicts health related quality of life in heart failure patients. Int J Cardiol. 2013;162(2):67–8. Adams KF, Piña IL, Ghali JK, Wagoner LE, Dunlap SH, Schwartz TA, et al. Prospective evaluation of the association between hemoglobin concentration and quality of life in patients with heart failure. Am Heart J. 2009;158(6):965–71. Tables Table 1 Demographic and lifestyle characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226) Variables Category Frequency (Percent) Mean±SD Age 51.12 ± 13.17 Age <50 108 (47.8%) ≥50 118 (52.2%) Sex Male 110 (48.7%) Female 116 (51.3%) Residence Rural 112 (49.6%) Urban 114 (50.4%) Marital Status Married 137 (60.6%) Single 27 (11.9%) Divorced 28 (12.4%) Widowed 34 (15%) Occupation Farmer 59 (26.1%) Merchant 50 (22.1%) Housewife 76 (33.6%) Employee: Government & nongovernment 41 (18.1%) Level of Education No formal education 94 (41.6%) Primary school 51 (22.6%) Secondary school 38 (16.8%) College and above 43 (19%) Smoking No 204 (90.3%) Yes 22 (9.7%) Alcohol No 180 (79.6%) Yes 46 (20.4%) Salt intake No 151 (66.8%) Yes 75 (33.2 %) Table 2 Clinical Characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226) Variables Category Frequency (Percent) Median(IQR) Systolic BP (mmHg) 105 (20) Systolic BP (mmHg) Normal(90-139) 158(69.9%) Hypotension(<90) 62(27.4%) Hypertension (≥ 140) 6(2.7%) Heart Rate (bpm) 89 (23) Heart Rate (bpm) Normal(60-100) 142(62.8%) Bradycardia(100) 81(35.8%) Duration of HFrEF (years) 1.5 (1) Duration of HFrEF (years) Less than a year 49(21.7%) More than a year 177(78.3%) NYHA class I&II 106 (46.9%) III&IV 120 (53.1%) Hospitalization within 6 months No 124 (54.9%) Yes 102 (45.1%) Etiology of HFrEF IHD 90 (39.8%) DCMP 55 (24.3%) CRVHD 56 (24.8%) DVHD 25 (11.1%) Comorbidities No 94 (41.6%) Yes 132 (58.4%) Hypertension No 173 (76.5%) Yes 53 (23.5) Atrial fibrillation No 171 (75.7) Yes 55 (24.3) Thyrotoxicosis No 205 (90.7) Yes 21 (9.3) Obesity No 206 (91.2%) Yes 20 (8.8%) Diabetes No 201 (88.9) Yes 25 (11.1) Dyslipidaemia No 184 (81.4%) Yes 42 (18.6%) Medication ACEIs/ARBs No 18 (8%) Yes 208 (92%) b-Blockers No 54 (23.9%) Yes 172 (76.1%) Spironolactone No 153 (67.7%) Yes 73 (32.3%) Diuretics (furosemide) No 89 (39.4%) Yes 137 (60.6%) Digoxin No 220 (97.3%) Yes 6 (2.7%) Antiplatelets No 134 (59.3%) Yes 92 (40.7%) Anticoagulants No 170 (75.2%) Yes 56 (24.8%) Statins No 143 (63.3%) Yes 83 (36.7%) Table 3 Biochemical and echocardiographic characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226) Variables Category Frequency (Percent) Median(IQR) Hemoglobin, g/dl 13.5 (3.8) Hemoglobin, g/dl Normal 126(55.8%) Mild anemia 45(19.9%) Moderate anemia 43(19%) Severe anemia 12(5.3%) Creatinine, mg/dl 0.99 (0.83) Creatinine, mg/dl Normal 136(60.2%) High 90(39.8%) Serum sodium, mEq/L 137 (8) Serum sodium, mEq/L Normal 140(61.9%) Hyponatremia 81(35.8%) Hypernatremia 5(2.2%) Baseline Echocardiography LVEF, % 30 (7.25) Baseline Echocardiography LVEF Class From 30% to 40% (Moderate systolic dysfunction) 143 (63.3%) Less than 30% (Sever systolic dysfunction) 83 (36.7%) Baseline Echocardiography Pulmonary hypertension Severity Mild or none 141 (62.4%) Moderate or Sever 85 (37.6%) Table 4 Health-Related Quality of Life of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226) HRQoL Domains Mean±SD 95% Confidence Interval Cronbach's Alpha Physical (range 0 - 40) 17.69±10.46 (16.32 , 19.07) 0.98 Emotional (range 0 - 25) 10.70±6.34 (9.87 , 11.53) 0.98 Total (range 0 - 105) 47.36±47 (44.04 , 50.67) 0.99 Level of total HRQoL Frequency Percent Good (score 0 - 23) 71 31.4 Moderate (score 24 - 45) 56 24.8 Poor (score 46 - 105) 99 43.8 Table 5: Bivariable and multivariable logistic regression analysis of anemia among HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226) Variables Categories Anemia status of HFrEF patients COR with 95% CI P value AOR with 95% CI P value Anemic n (%) Non anemic n (%) Age <50 27(25) 81(75) 1 1 ≥50 73(61.9) 45(38.1) 4.86(2.74-8.62) <0.001 4.18(1.65-10.58) 0.003 Sex Male 35(31.8) 75(68.2) 1 Female 65(56) 51(44) 2.73(1.58-4.70) <0.001 Smoking No 86(42) 118(58) 1 Yes 14(63.6) 8(36.4) 2.40(0.96- 5.97) 0.060 Alcohol No 85(47.2) 95(52.8) 1 Yes 15(32.6) 31(67.4) 0.54(0.27-1.07) 0.077 Salt intake No 39(25.8) 112(74.2) 1 Yes 61(81.3) 14(18.7) 12.51(6.30- 24.84) <0.001 Systolic BP (mmHg) Normal 60(38) 98(62) 1 1 Hypotension 37(59.7) 25(40.3) 2.41(1.32-4.40) 0.004 3.96(1.33-11.75) 0.013 Hypertension 3(50%) 3(50%) 1.63(0.31-8.35) 0.556 0.20(0.01-2.14) 0.185 Heart Rate (bpm) Normal 29(20.4) 113(79.6) 1 Bradycardia 2(66.7) 1(33.3) 7.79(0.68-88.95) 0.098 Tachycardia 69(85.2) 12(14.8) 22.40(10.72-46.79) <0.001 Duration of HFrEF (years) Less than a year 31(25.6) 90(74.4) 1 1 More than a year 69(65.7) 36(34.3) 5.56(3.13-9.87) <0.001 4.60(1.76-11.97) 0.002 NYHA class I&II 25(23.6) 81(76.4) 1 III&IV 75(62.5) 45(37.5) 5.40(3.02-9.65) <0.001 Hospitalization within 6 months No 30(24.2) 94(75.8) 1 1 Yes 70(68.6) 32(31.4) 6.85(3.81-12.32) <0.001 3.31(1.42-7.67) 0.005 Comorbidities No 26(27.7) 68(72.3) 1 1 Yes 74(56) 58(44) 3.33(1.89-5.88) <0.001 6.36(2.28-17.76) <0.001 Hypertension No 67(38.7) 106(61.3) 1 Yes 33(62.3) 20(37.7) 2.61(1.38- 4.92) 0.003 Atrial fibrillation No 50(29.2) 121(70.8) 1 Yes 50(90.9) 5(9.1) 24.20(9.11- 64.25) <0.001 Thyrotoxicosis No 88(43) 117(57) 1 Yes 12(57.1) 9(42.9) 1.77(0.71- 4.39) 0.216 Diabetes No 80(39.8) 121(60.2) 1 Yes 20(80) 5(20) 6.05(2.18-16.77) 0.001 Dyslipidaemia No 68(37) 116(63) 1 Yes 32(76.2) 10(23.8) 5.45(2.52-11.79) <0.001 Medications b-Blockers No 20(37) 34(63) 1 Yes 80(46.5) 92(53.5) 1.47(0.78-2.77) 0.223 Diuretics (furosemide) No 21(23.6) 68(76.4) 1 Yes 79(57.7) 58(42.3) 4.41(2.43-7.99) <0.001 Antiplatelets No 48(35.8) 86(64.2) 1 Yes 52(56.5) 40(43.5) 2.32(1.35-4) 0.002 Anticoagulants No 69(40.6) 101(59.4) 1 Yes 31(55.4) 25(44.6) 1.81(0.98-3.33) 0.055 Creatinine, mg/dl Normal 39(28.7) 97(71.3) 1 High 61(67.8) 29(32.2) 5.23(2.93-9.32) <0.001 Serum sodium, mEq/L Normal 31(22.1) 109(77.9) 1 Hyponatremia 67(82.7) 14(17.3) 16.82(8.35-33.90) <0.001 Hypernatremia 2(40) 3(60) 2.34(0.37-14.65)) 0.362 Baseline Echo LVEF class Moderate 37(37) 63(63) 1 1 Severe 63(75.9) 20(24.1) 9.02(4.82-16.89) <0.001 3.12(1.29-7.52) 0.011 Level of HRQoL Better 33(26) 94(74) 1 1 Poor 67(67.7) 32(32.3) 5.96(3.34-10.63) <0.001 10.52(3.9-28.36) <0.001 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6856747","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":474387633,"identity":"4e08b1ed-a95d-4890-825e-586d5d1348e8","order_by":0,"name":"Daniel Belay Agonafir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYDCCAwwGDEAkY8DA3ADkMsuBBR8QoYXHgIERrMUYLJhAUAsDQksiiGTAp4Xv9uGNnwsKbHjM2RsbP/PmWKfPDzv8EGiLnZxuA3YtkufSiqVnGKTxWPYcbJbm3Zaeu/F2mgFQS7Kx2QHsWgzO8BhI8xgc5jG4kdgA1HI4d+PsBJCWA4nbcGsx/s1j8J/H4P7D5t9ALemGs9M/ENJiBrTlANAWxjaQLQny0jn4bZE8w1ZmzWOQDPRLYpvl3G3phhukcwoOJBjg9gvfGebNt3n+2MmZsx8+fOPtNmt5+dnpmz98qLCTw6UFBTDxgJwKVmlAhHIQYPwBJOQbiFQ9CkbBKBgFIwYAAGp9YlmCWvGBAAAAAElFTkSuQmCC","orcid":"","institution":"Wachemo University","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"Belay","lastName":"Agonafir","suffix":""},{"id":474387634,"identity":"f899f0f6-65c5-462d-b61f-8ed8e832b2f7","order_by":1,"name":"Biruk Mulat Worku","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Biruk","middleName":"Mulat","lastName":"Worku","suffix":""},{"id":474387636,"identity":"0d58d9bc-0fe0-4745-b019-e1df2e52ac20","order_by":2,"name":"Hailemaryam Alemu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Hailemaryam","middleName":"","lastName":"Alemu","suffix":""},{"id":474387637,"identity":"639518be-8547-40e8-9ad2-b0ab2a878d5c","order_by":3,"name":"Andinet Azaje Alemu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Andinet","middleName":"Azaje","lastName":"Alemu","suffix":""},{"id":474387638,"identity":"1f55444d-2152-44d5-b95d-57dcbd996f19","order_by":4,"name":"Gebrehiwot Lema Legese","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Gebrehiwot","middleName":"Lema","lastName":"Legese","suffix":""}],"badges":[],"createdAt":"2025-06-09 18:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6856747/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6856747/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-05039-2","type":"published","date":"2025-07-31T16:05:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85305756,"identity":"7ed33106-4c62-4292-908a-6cf41a876a8d","added_by":"auto","created_at":"2025-06-24 12:40:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26830,"visible":true,"origin":"","legend":"\u003cp\u003eHRQoL differences in the proportion of anemia among HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6856747/v1/4944c546e3878511c8bcf0e8.png"},{"id":88268298,"identity":"9f7da97b-2623-4ee6-aab7-888ca4d4a489","added_by":"auto","created_at":"2025-08-04 16:50:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1249241,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6856747/v1/c4c33e5d-62e0-4759-82bb-d8ea7abb47ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Anemia, Its Associated Factors, and Impact on Quality of Life Among Heart Failure with Reduced Ejection Fraction Outpatients at the University of Gondar Hospital, Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eHeart Failure (HF) is a complex and life-threatening condition that significantly impacts morbidity, mortality, functional ability, quality of life, and healthcare costs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As a global public health concern, it affects an estimated 64.3\u0026nbsp;million people worldwide, with roughly half of the cases classified as Heart Failure with Reduced Ejection Fraction (HFrEF)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Sub-Saharan Africa, HF remains a major health challenge and is among the top five leading causes of death in Ethiopia(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnemia is a frequent comorbidity in heart failure patients, particularly those with HFrEF, with studies suggesting that over one-third of HFrEF patients are affected. The reported prevalence of anaemia in this population varies significantly depending on factors such as patient demographics, the diagnostic criteria used, HF severity, and the presence of additional comorbidities (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Notably, prevalence can reach up to 50% in hospitalized patients with acute heart failure decompensation (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe development of anaemia in HF patients stems from a complex interplay of factors, including chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, micronutrient deficiencies, and conditions causing blood loss (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The predominant form is anaemia of chronic disease, driven by renal dysfunction, impaired erythropoiesis, reduced erythropoietin (EPO) responsiveness, and systemic inflammation. Additionally, plasma volume expansion and hemodilution may contribute to pseudoanaemia. Certain medications, such as angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), have also been associated with anaemia due to their suppression of EPO synthesis and bone marrow activity. While deficiencies in iron, folate, and vitamin B12 play a role, iron deficiency accounts for a significant proportion of cases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Independent risk factors for anaemia in HF include male sex, advanced age, higher NYHA functional class, lower systolic blood pressure, CKD, diabetes, ischemic aetiology, and the use of diuretics and ACEIs/ARBs (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnaemia in HF is associated with increased hospitalization rates, higher morbidity and mortality, and diminished quality of life (QoL) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The correlation between anemia and QoL can be attributed to several factors. Anemia often leads to increased fatigue, decreased exercise tolerance, and greater difficulty in performing daily activities, thereby negatively impacting the health-related QoL. Additionally, the presence of anemia has been associated with increased symptoms of depression and anxiety in patients with HF, further deteriorating QoL. Early treatment of anemia may therefore enhance both clinical outcomes and overall patient QoL (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite its clinical significance, there is limited research on anaemia in HF patients within our region. This study aims to assess the prevalence of anaemia, identify associated factors, and evaluate its impact on quality of life among HFrEF patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003e\u003cstrong\u003eStudy design, setting, and population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was a cross-sectional, institution-based study conducted from August 2023 to January 2024 at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) in North West Ethiopia. This facility ranks among the largest hospitals in the country, offering health services to approximately 13 million individuals within its catchment area. UoGCSH features several follow-up clinics dedicated to major chronic illnesses, one of which is the Cardiac clinic. Currently, around 3,000 cardiac patients receive ongoing care at this specialized clinic.\u003c/p\u003e\n\u003cp\u003eThe source population comprised all adult patients diagnosed with HFrEF who were under chronic follow-up at the UoGCSH. The study population included all adult patients with HFrEF who attended the chronic follow-up clinic at UoGCSH throughout the defined study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdult patients aged 18 years and older diagnosed with HFrEF who had received follow-up care at the cardiac clinic of the UoGCSH for a minimum duration of three months were included in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria comprised \u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePatients with cognitive impairments (e.g., dementia, psychosis) affecting recall ability.\u003c/li\u003e\n \u003cli\u003eThose with acute concurrent conditions (e.g., acute heart failure exacerbations, severe infections) that could substantially alter quality of life.\u003c/li\u003e\n \u003cli\u003ePregnant women and patients receiving iron supplementation or blood transfusions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using Epi Info, based on an 82% prevalence from a prior study in Nepal (17), a 95% confidence interval, and a 5% marginal error. Adding a 10% non-response rate, the total sample size was 232.\u003c/p\u003e\n\u003cp\u003eA consecutive sampling technique was utilized, enrolling all eligible patients until the target sample size was reached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using structured questionnaires, covering:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSociodemographic, lifestyle, clinical, biochemical, and echocardiographic variables.\u003c/li\u003e\n \u003cli\u003eHealth-Related Quality of Life (HRQoL), assessed via the Minnesota Living with Heart Failure Questionnaire (MLHFQ)\u0026mdash;a globally validated tool for HF patients (18, 19).\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe MLHFQ was translated into Amharic (local language) and back-translated to English to ensure consistency.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eClinical, biochemical, and echocardiographic data were extracted from medical records. For lab parameters (hemoglobin, serum creatinine, serum sodium), three-month averages prior to the visit were used. Analyses were performed using Yumizen H550 (hematology) and AU480 (chemistry) automated analyzers.\u003c/li\u003e\n \u003cli\u003eSociodemographic and MLHFQ data were obtained through face-to-face interviews conducted by two trained cardiac nurses, supervised by a general practitioner.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTraining: Data collectors and supervisors received instruction on protocols, study objectives, and confidentiality.\u003c/li\u003e\n \u003cli\u003ePretesting: A pilot test with 20 participants evaluated questionnaire clarity, language appropriateness, and reliability.\u003c/li\u003e\n \u003cli\u003eDaily monitoring: The principal investigator and supervisor reviewed data for accuracy and completeness throughout the collection phase.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study shared methodological similarities with a prior study conducted in the same setting (20), particularly in terms of design, duration, study population, and data collection tools and procedures. However, it differed in its inclusion/exclusion criteria and had distinct study objectives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnemia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic Factors: Age, gender, place of residence, marital status, educational attainment, occupation, and income level.\u003c/p\u003e\n\u003cp\u003eLifestyle Factors: Current smoking habits, alcohol consumption, and dietary salt intake.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical Factors:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eVital signs: Systolic blood pressure (SBP), heart rate (HR).\u003c/li\u003e\n \u003cli\u003eHF characteristics: Duration of HF, etiology (ischemic heart disease [IHD], dilated cardiomyopathy [DCMP], chronic rheumatic valve disease [CRVHD], degenerative valvular heart disease [DVHD], others).\u003c/li\u003e\n \u003cli\u003eDisease severity: NYHA functional class (I\u0026ndash;IV), recent hospitalization (past 6 months).\u003c/li\u003e\n \u003cli\u003eComorbidities: Atrial fibrillation, hypertension, obesity, dyslipidemia, diabetes mellitus (DM), chronic kidney disease (CKD), etc.\u003c/li\u003e\n \u003cli\u003eMedications: Diuretics, beta-blockers, ACEIs/ARBs, spironolactone, digoxin, antiplatelets, anticoagulants, statins, etc.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBiochemical Factors: Hemoglobin, Serum creatinine, Serum sodium (averaged from results obtained over the past three months).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEchocardiographic Factors: Left ventricular ejection fraction (LVEF) and pulmonary hypertension (PH) severity at HF diagnosis.\u003c/p\u003e\n\u003cp\u003eHealth related quality of life: assessed by Minnesota Living with Heart Failure Questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnemia was defined according to World Health Organization (WHO) criteria as hemoglobin levels below 12 g/dL for non-pregnant women and below 13 g/dL for men. The WHO further classifies anemia severity as follows. In men: Mild anemia (11\u0026ndash;12.9 g/dL), Moderate anemia (8\u0026ndash;10.9 g/dL) and Severe anemia (\u0026lt; 8 g/dL). In non-pregnant women: \u0026nbsp;Mild anemia (11\u0026ndash;11.9 g/dL), Moderate anemia (8\u0026ndash;10.9 g/dL) and Severe anemia (\u0026lt; 8 g/dL)(21).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHeart failure with reduced ejection fraction patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDefined as HF patients with an echocardiographically confirmed LVEF \u0026le;40%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth-related quality of life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth-related quality of life in patients with HF is an important patient-reported health status measure that evaluates the impact of HF and its medical interventions on various domains of life. It is evaluated using the MLHFQ, which consists of\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e21 items rated on a 6-point Likert scale (0 = no impact, 5 = severe impact).\u003c/li\u003e\n \u003cli\u003eTotal score range: 0\u0026ndash;105 (higher scores indicate worse HRQoL).\u003c/li\u003e\n \u003cli\u003eSubscales:\u0026nbsp;Physical domain (items 2\u0026ndash;7, 12\u0026ndash;13; range 0\u0026ndash;40), Emotional domain (items 17\u0026ndash;21; range 0\u0026ndash;25).\u003c/li\u003e\n \u003cli\u003eClassification:\u0026nbsp;Good HRQoL: \u0026lt;24, Moderate HRQoL: 24\u0026ndash;45, Poor HRQoL: \u0026gt;45 (22).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eNew York Heart Association (NYHA) Functional Class\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClass I: No limitations in physical activity.\u003c/p\u003e\n\u003cp\u003eClass II: Mild limitations (comfortable at rest, but ordinary activity causes symptoms).\u003c/p\u003e\n\u003cp\u003eClass III: Marked limitations (comfortable at rest, but minimal activity triggers symptoms).\u003c/p\u003e\n\u003cp\u003eClass IV: Symptoms at rest; inability to perform any physical activity without discomfort (23).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe collected data were entered into Epi Data version 4.6 and analyzed using SPSS version 25 after verifying data integrity. A reliability test (Cronbach\u0026rsquo;s alpha) was performed to assess the consistency of the items in the MLHFQ tool, yielding values of 0.99 for overall HRQoL, 0.98 for the physical domain, and 0.98 for the emotional domain. Descriptive analyses, including frequencies, means, and medians, were conducted. To identify factors associated with anemia, both bivariable and multivariable logistic regression analyses were employed. Variables with p-values \u0026lt;0.25 in the bivariable analysis were included in the multivariable model, and those with p-values \u0026le;0.05 were considered statistically significant. Model fitness was evaluated using the Hosmer-Lemeshow test, which yielded a p-value of 0.4 (\u0026gt;0.05), indicating a good fit. The findings were systematically organized and presented using frequency tables and graphs.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic and lifestyle characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 226 patients with HFrEF under follow-up at a cardiac clinic, achieving a response rate of 97.4%. The majority (52.2%) were over 50 years old, with a mean age of 51.12 ± 13.17 years.\u003c/p\u003e\n\u003cp\u003eAmong the participants, 51.3% were female, 50.4% resided in urban areas, and 60.6% were married. Nearly one-third (33.6%) were housewives, while 41.6% had no formal education.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding lifestyle factors, 9.7% were current smokers, 33.2% reported high salt intake, and 20.4% were current alcohol drinkers (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical, biochemical and echocardiographic Characteristics\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study participants had a median (IQR) SBP of 105 (20) mmHg (range: 75–150), with 27.4% experiencing hypotension. The median (IQR) HR was 89 (23) bpm (range: 40–112), and 35.8% of patients had tachycardia. The median (IQR) illness duration was 1.5 (1.0) years (range: 6 months–6 years), with 78.3% of patients having HF for over a year.\u003c/p\u003e\n\u003cp\u003eMost participants (53.1%) were classified as NYHA class III or IV, and 45.1% had been hospitalized within the past six months. The primary etiologies of HFrEF identified were IHD (39.8%), CRVHD (24.8%), DCMP (24.3%), and DVHD (11.1%).\u003c/p\u003e\n\u003cp\u003eAmong the participants, 58.4% had at least one comorbidity; including atrial fibrillation (24.3%), hypertension (23.5%), dyslipidemia (18.6%),\u0026nbsp;diabetes (11.1%), thyrotoxicosis (9.3%), and\u0026nbsp;obesity (8.8%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedication use was as follows: ACEIs/ARBs (92%), beta-blockers (76.1%), furosemide (60.6%), antiplatelets (40.7%), statins (36.7%), spironolactone (32.3%), anticoagulants (24.8%), and digoxin (2.7%) (Table 2).\u003c/p\u003e\n\u003cp\u003eThis study included the mean values of laboratory results obtained over the past three months. The median (IQR) values were as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHemoglobin (Hg): 13.5 (3.8) g/dL (range: 7–16.9 g/dL), with 34.2% of patients exhibiting low Hg levels. Creatinine (Cr): 0.99 (0.83) mg/dL (range: 0.45–3.3 mg/dL), with 39.8% of patients having elevated Cr. Sodium (Na): 137 (8) mEq/L (range: 120–150 mEq/L), with 35.8% of patients having hyponatremia.\u003c/p\u003e\n\u003cp\u003eRegarding cardiac function: on baseline echocardiography, LVEF was a median (IQR) of 30 (7.25)% (range: 14–40%), with 36.7% of patients having severe systolic dysfunction and 63.3% exhibiting moderate systolic dysfunction. 62.4% had mild or no PH, while 37.6% had moderate or severe PH. (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePrevalence of Anemia\u003c/em\u003e\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eand its impact on Quality of Life\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy participants’ chart review was conducted to evaluate the prevalence of anemia among HFrEF patients. Out of 226 HFrEF patients on follow-up at UoGCSH, 100 (44.2%) were found to have anemia. This study confirms an overall anemia prevalence of 44.2% (95% CI: 37.7–51.0) in this patient population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong anemic HFrEF patients, 45 (45%) of patients had mild anemia, 43 (43%) had moderate anemia and 12 (12%) of patients had severe anemia.\u003c/p\u003e\n\u003cp\u003eIn this study, the MLHFQ was used to evaluate HRQoL, revealing mean scores of 17.69 ± 10.46 for physical domain, 10.70 ± 6.34 for emotional domain, and 47.36 ± 47 for total HRQoL. 43.8% of participants were classified as having a poor HRQoL, while 24.8% and 31.4% were assessed as having moderate and good HRQoL, respectively (Table 4).\u003c/p\u003e\n\u003cp\u003eAmong anemic HFrEF patients, 82 (82%) of patients had poor HRQoL while 8 (8%) had moderate HRQoL and 10(10%) patients had good HRQoL (Fig 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFactors associated with Anemia\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the Bivariable logistic regression: patient age, sex, smoking and alcohol history, salt intake, SBP, HR, duration of HF, NYHA class, recent hospitalization, comorbidities (hypertension, diabetes mellitus, atrial fibrillation, thyrotoxicosis, dyslipidemia), HF medications (β-blockers, furosemide, antiplatelets, anticoagulants), serum creatinine and sodium levels, baseline echocardiography LVEF, and HRQoL were included as candidate variables for multivariable logistic regression analysis at a significance level of 0.25.\u003c/p\u003e\n\u003cp\u003eIn multivariable logistic regression analysis, seven significant predictors of anemia in HFrEF patients were identified. \u0026nbsp;Age ≥50 years: AOR 4.18 (95% CI: 1.65–10.58), Hypotension (SBP\u0026lt;90 mmHg): AOR 3.96 (95% CI: 1.33–11.75), HF duration ≥1 year: AOR 4.60 (95% CI: 1.76–11.97), Recent hospitalization: AOR 3.31 (95% CI: 1.42–7.67), Presence of comorbidities: AOR 6.36 (95% CI: 2.28–17.76), Severely reduced LVEF: AOR 3.12 (95% CI: 1.29–7.52), and Poor HRQoL: AOR 10.52 (95% CI: 3.9–28.36) (Table 5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides important insights into the burden of anemia, its contributing factors, and its profound impact on the well-being of HFrEF patients. The findings highlight anemia as a highly prevalent and clinically significant comorbidity in this population, intricately linked to both disease severity and patient-reported outcomes.\u003c/p\u003e \u003cp\u003eThe observed anemia prevalence of 44.2% (95% CI: 37.7\u0026ndash;51.0) among HFrEF patients in this study underscores its substantial burden. This rate was comparable to that of general HF patients at Brazzaville University Hospital, Congo (42%)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and to Asian patients with HFrEF (41%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, our finding is higher than the prevalence of 27% reported in a study from Saudi Arabia and significantly lower than the 82% reported in Nepal (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This large variability may be explained by demographic and methodological differences.\u003c/p\u003e \u003cp\u003eThis elevated prevalence likely reflects a confluence of factors prevalent in this population and setting, including nutritional deficiencies (iron, folate, vitamin B12), a high burden of chronic infections/inflammation (e.g., malaria, helminths, tuberculosis), CKD often associated with HF, and potentially limited access to optimal HF management and anemia diagnostics/treatment prior to presentation. The finding reinforces that anemia is not merely a bystander but a major comorbidity demanding attention in HFrEF care (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study identified factors associated with anemia among HFrEF patients. The odds of developing anemia in HFrEF patients aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years were 4.18 times higher, a finding consistent with previous studies in Asian (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and Swedish populations (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This strong association aligns with physiological aging processes, including reduced erythropoietin responsiveness, a higher prevalence of comorbidities contributing to anemia (e.g., CKD, occult malignancies), and potential nutritional deficiencies. It underscores the need for heightened vigilance for anemia in older HFrEF patients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, hypotensive HFrEF patients had 3.96 times higher odds of anemia compared to normotensive patients, consistent with studies from Nigeria (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Sweden (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Low systolic blood pressure often reflects advanced HF, reduced cardiac output, and consequently, impaired renal perfusion. This can suppress erythropoietin production, directly linking hemodynamic compromise to anemia development (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHFrEF patients with a disease duration of \u0026ge;\u0026thinsp;1 year had 4.6 times higher odds of anemia than those with shorter durations. Longer disease duration signifies greater cumulative exposure to the pathophysiological mechanisms linking HF and anemia, including chronic inflammation, neurohormonal activation (e.g., RAAS overactivity), renal dysfunction, and potentially the effects of long-term loop diuretic use (e.g., iron loss)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHFrEF patients with a recent hospitalization history had 3.31 times higher odds of anemia, mirroring findings in Swedish studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Hospitalization is a marker of HF instability, disease severity, and acute decompensation. These states exacerbate inflammation, hemodynamic compromise affecting renal function, and nutritional deficiencies, all contributing to or worsening anemia. Anemia itself can also precipitate hospitalization, suggesting a potential bidirectional relationship(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of anemia among HFrEF patients with comorbidities was 6.36 times higher, aligning with studies from Thailand (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and Sweden (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Comorbidities like CKD (impairing erythropoietin production and iron metabolism), diabetes (associated with anemia of chronic disease and CKD), chronic inflammatory conditions, and occult blood loss significantly amplify anemia risk (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHFrEF patients with severely reduced LVEF had 3.12 times higher odds of anemia than those with moderate LVEF, consistent with Nigerian data (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). More severe systolic dysfunction correlates with worse cardiac output, lower renal perfusion, greater neurohormonal activation, and higher levels of inflammatory cytokines, all established pathways contributing to anemia in HF. This links the core pathophysiology of HFrEF directly to anemia risk (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, anemia prevalence was 10.52 times higher in HFrEF patients with poor HRQoL, matching findings from Nigeria (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Iran (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), Asia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This suggests a profound link between anemia and diminished quality of life. Anemia likely exacerbates fatigue, dyspnea, and exercise intolerance, impairing daily functioning, while poor HRQoL may reflect or worsen HF and anemia severity (\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStrengths of the study include its focus on a clinically important comorbidity in an understudied population, the use of adjusted analyses to identify independent predictors, and the inclusion of patient-centered HRQoL outcomes.\u003c/p\u003e \u003cp\u003eLimitations include the single-center design, which may limit generalizability; the cross-sectional nature of the study, preventing causal inference; possible residual confounding due to unmeasured variables (e.g., detailed nutritional status, specific comorbidities, medication adherence); and the lack of data on anemia subtypes (e.g., iron deficiency).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAnemia is highly prevalent (44.2%) among HFrEF patients and is strongly associated with factors indicative of advanced disease and comorbidity burden (older age, hypotension, longer HF duration, recent hospitalization, comorbidities, severely reduced LVEF). Crucially, anemia is independently and very strongly associated with poor Health-Related Quality of Life, affecting the vast majority of anemic patients. These findings underscore the critical importance of recognizing anemia as a key determinant of morbidity and impaired well-being in HFrEF patients. Integrating routine anemia screening, etiological investigation, and management into standard HF care protocols, particularly for high-risk individuals, holds significant potential to alleviate symptoms, improve functional capacity and quality of life, and potentially modify the disease trajectory in this vulnerable population. Future research should focus on longitudinal outcomes and targeted interventions for anemia in this setting.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACEI, Angiotensin converting enzyme inhibitor; ARB, Angiotensin receptor blocker; bbp, beat per minutes; CRVHD, Chronic rheumatic valvular heart disease; CKD, Chronic kidney disease; DCMP, Dilated cardiomyopathy; DM, Diabetes mellitus; DVHD, Degenerative valve heart disease; EPO, Erythropoietin; Hb, Hemoglobin; HF, Heart failure; HFrEF, Heart failure with reduced ejection fraction; HRQoL, Health-Related Quality of Life; HR, Heart rate; IHD, Ischemic heart disease; LVEF, Left ventricular ejection fraction; MLHFQ, Minnesota Living with Heart Failure Questionnaire ; mmHg, Millimetres of mercury, NYHA, New York Heart Association; Pulmonary hypertension, PH; QoL, Quality of life; RAAS, Renin angiotensin aldosterone system; SBP, Systolic blood pressure; UoGCSH, University of Gondar Comprehensive Specialized Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Ethical Review Board of the School of Medicine, College of Medicine and Health Sciences, University of Gondar (Reference No.: SOM/06/01659/2015; Approval Date: May 18, 2023).\u0026nbsp;Written informed consent was obtained from all participants prior to their inclusion in the study. To ensure participant privacy, all collected information was handled with strict confidentiality. Personally identifiable details, such as names, were not recorded at any stage of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: DB \u0026nbsp; Data curation: DB \u0026nbsp; Formal Analysis: DB \u0026nbsp; Investigation: DB \u0026nbsp; Methodology: DB, BM, HA, AA, GL \u0026nbsp; Project administration: DB, BM, HA, AA, GL \u0026nbsp; Resources: DB \u0026nbsp; Supervision: DB, BM, HA, AA, GL \u0026nbsp; Visualization: DB, BM, HA, AA, GL \u0026nbsp; Writing \u0026ndash; original draft: DB, BM, HA, AA, GL \u0026nbsp; Writing \u0026ndash; review \u0026amp; editing: DB, BM, HA, AA, GL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their gratitude to the staff and study participants for their invaluable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSavarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovascular Res. 2023;118(17):3272\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u0026ndash;2017: a systematic analysis for the Global Burden of Disease Study 2017. lancet. 2018;392(10159):1789\u0026ndash;858.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavarese G, Becher PM, Lund LH, Seferovic P, Rosano GM, Coats AJ. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovascular Res. 2022;118(17):3272\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBloomfield GS, Barasa FA, Doll JA, Velazquez EJ. Heart failure in sub-Saharan Africa. Curr Cardiol Rev. 2013;9(2):157\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies. Circulation. 2018;138(1):80\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCullough PA, Barnard D, Clare R, Ellis SJ, Fleg JL, Fonarow GC, et al. Anemia and associated clinical outcomes in patients with heart failure due to reduced left ventricular systolic function. Clin Cardiol. 2013;36(10):611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrote Beverborg N, van Veldhuisen DJ, van der Meer P. Anemia in heart failure: still relevant? JACC. Heart Fail. 2018;6(3):201\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCullough PA, Barnard D, Clare R, Ellis SJ, Fleg JL, Fonarow GC, et al. Anemia and associated clinical outcomes in patients with heart failure due to reduced left ventricular systolic function. Clin Cardiol. 2013;36(10):611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegi PC, Dev M, Paul P, Pal Singh D, Rathoure S, Kumar R, et al. Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry. Indian Heart J. 2018;70:S182\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMentz RJ, Greene SJ, Ambrosy AP, Vaduganathan M, Subacius HP, Swedberg K, et al. Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial. Circulation Heart Fail. 2014;7(3):401\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqui SW, Ashok T, Patni N, Fatima M, Lamis A, Anne KK. Anemia and Heart Failure: A Narrative Review. Cureus. 2022;14(7):e27167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh B, Bajaj N, Singh P, Kumar Ghosh A, Anathakrishnan R, Singh N. Iron deficiency in patients of heart failure with reduced ejection fraction. Med J Armed Forces India. 2022;78(4):463\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavarese G, Jonsson \u0026Aring;, Hallberg AC, Dahlstr\u0026ouml;m U, Edner M, Lund LH. Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum. Int J Cardiol. 2020;298:59\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerry C, Poppe KK, Gamble GD, Earle NJ, Ezekowitz JA, Squire IB, et al. Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis. QJM: monthly J Association Physicians. 2016;109(6):377\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoh VJ, Tromp J, Teng TK, Tay WT, Van Der Meer P, Ling LH, et al. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC heart Fail. 2018;5(4):570\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia H, Shen H, Cha W, Lu Q. The Prognostic Significance of Anemia in Patients With Heart Failure: A Meta-Analysis of Studies From the Last Decade. Front Cardiovasc Med. 2021;Volume 8\u0026ndash;2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhandari A, Shah P, Pandey NK, Nepal R, Sherchand O. Anaemia among Patients of Heart Failure in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study. JNMA. 2021;59(241):833\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilbao A, Escobar A, Garc\u0026iacute;a-Perez L, Navarro G, Quir\u0026oacute;s R. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14:23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLouredo ABd, Leite ALC, Salerno GRF, Fernandes M, Blascovi-Assis S. Instruments to assess quality of life in patients with heart failure. Fisioterapia em Movimento. 2015;28:851\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelay Agonafir D, Mulat Worku B, Alemu H, Nega Godana T, Fentahun Bekele S, Andargie Berhane A, et al. Health-related quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Hospital, Ethiopia. Front Cardiovasc Med. 2024;11:1436335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System Geneva. World Health Organization; 2011 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehlouli H, Feldman DE, Ducharme A, Frenette M, Giannetti N, Grondin F et al. Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual International Conference. 2009;2009:6242-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller-Davis C, Marden S, Leidy NK. The New York Heart Association Classes and functional status: what are we really measuring? Heart lung: J Crit care. 2006;35(4):217\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkama MS, Nsitou BM, Kocko I, Mongo NS, Kimbally-Kaky G, Nkoua JL. Prevalence of anaemia among patients with heart failure at the Brazzaville University Hospital. Cardiovasc J Afr. 2015;26(3):140\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJonsson A, Hallberg A-C, Edner M, Lund LH, Dahlstrom U. A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry. Int J Cardiol. 2016;211:124\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkintunde AA, Aworanti OW, PATTERN OF ANAEMIA, AND ITS CORRELATES IN NIGERIANS WITH HEART FAILURE. Annals Ib Postgrad Med. 2020;18(1):51\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavarese G, Jonsson \u0026Aring;, Hallberg A-C, Dahlstr\u0026ouml;m U, Edner M, Lund LH. Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum. Int J Cardiol. 2020;298:59\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThantassanee P, Janwanishstaporn S. Prevalence and factors affecting anemia among patients with chronic heart failure with reduced or mildly reduced ejection fraction, Samutsakorn Hospital. J Nakornping Hosp. 2024;15(1):32\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma YP, Kaur N, Kasinadhuni G, Batta A, Chhabra P, Verma S, et al. Anemia in heart failure: still an unsolved enigma. Egypt Heart J. 2021;73(1):75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnand IS. Heart failure and anemia: mechanisms and pathophysiology. Heart Fail Rev. 2008;13(4):379\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexandrakis MG, Tsirakis G. Anemia in heart failure patients. Int Sch Res Notices. 2012;2012(1):246915.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeighmi Mohammadi S, Shahparian M. Correlation between hemoglobin level and quality of life in male patients with systolic heart failure. Sci J Iran Blood Transfus Organ. 2012;9(2):160\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCom\u0026iacute;n-Colet J, Mart\u0026iacute;n Lorenzo T, Gonz\u0026aacute;lez-Dom\u0026iacute;nguez A, Oliva J, Jim\u0026eacute;nez Merino S. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes. 2020;18:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoehner W, von Haehling S, Anker SD. Anaemia predicts health related quality of life in heart failure patients. Int J Cardiol. 2013;162(2):67\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams KF, Pi\u0026ntilde;a IL, Ghali JK, Wagoner LE, Dunlap SH, Schwartz TA, et al. Prospective evaluation of the association between hemoglobin concentration and quality of life in patients with heart failure. Am Heart J. 2009;158(6):965\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Demographic and lifestyle characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eFrequency (Percent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e51.12 \u0026plusmn; 13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e108 (47.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e118 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e110 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e116 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e112 (49.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e114 (50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e137 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e27 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e28 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e34 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e59 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e50 (22.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e76 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eEmployee: Government \u0026amp; nongovernment \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e41 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eLevel of Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e94 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e51 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e38 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e43 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e204 (90.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e22 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e180 (79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e46 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSalt intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e151 (66.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e75 (33.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 Clinical Characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFrequency (Percent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e105 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNormal(90-139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e158(69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eHypotension(\u0026lt;90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e62(27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eHypertension (\u0026ge; 140)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHeart Rate (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e89 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHeart Rate (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNormal(60-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e142(62.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eBradycardia(\u0026lt;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3(1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eTachycardia(\u0026gt;100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e81(35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDuration of HFrEF (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDuration of HFrEF (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eLess than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e49(21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMore than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e177(78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNYHA class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eI\u0026amp;II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e106 (46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eIII\u0026amp;IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e120 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHospitalization within 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e124 (54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e102 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEtiology of HFrEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eIHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e90 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eDCMP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e55 (24.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eCRVHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e56 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eDVHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e94 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e132 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e173 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e53 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Atrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e171 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e55 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Thyrotoxicosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e205 (90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e21 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e206 (91.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e20 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e201 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Dyslipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e184 (81.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e42 (18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMedication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;ACEIs/ARBs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e18 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e208 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;b-Blockers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e54 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e172 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Spironolactone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e153 (67.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e73 (32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Diuretics (furosemide)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e89 (39.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e137 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Digoxin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e220 (97.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Antiplatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e134 (59.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e92 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Anticoagulants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e170 (75.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e56 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Statins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e143 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e83 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 Biochemical and echocardiographic characteristics of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eFrequency (Percent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eHemoglobin, g/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13.5 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eHemoglobin, g/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e126(55.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMild anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e45(19.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eModerate anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e43(19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSevere anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12(5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eCreatinine, mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.99 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eCreatinine, mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e136(60.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e90(39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eSerum sodium, mEq/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e137 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eSerum sodium, mEq/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e140(61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHyponatremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e81(35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHypernatremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5(2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eBaseline Echocardiography LVEF, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e30 (7.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eBaseline Echocardiography\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLVEF Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eFrom 30% to 40% (Moderate systolic dysfunction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e143 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLess than 30% (Sever systolic dysfunction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e83 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eBaseline Echocardiography \u0026nbsp;Pulmonary hypertension Severity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMild or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e141 (62.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eModerate or Sever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e85 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Health-Related Quality of Life of HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eHRQoL Domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eCronbach\u0026apos;s Alpha\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Physical (range 0 - 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17.69\u0026plusmn;10.46\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e(16.32 , 19.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Emotional (range 0 - 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10.70\u0026plusmn;6.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e(9.87 , 11.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Total (range 0 - 105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47.36\u0026plusmn;47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e(44.04 , 50.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eLevel of total HRQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Good (score 0 - 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderate \u0026nbsp;(score 24 - 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Poor (score 46 - 105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5: Bivariable and multivariable logistic regression analysis of anemia among HFrEF outpatients at UoGCSH North West Ethiopia, 2023 (n=226)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAnemia status of HFrEF patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCOR with 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eAOR with 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eAnemic\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNon anemic\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e27(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e81(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e73(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e45(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.86(2.74-8.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e4.18(1.65-10.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e35(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e75(68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e65(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e51(44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.73(1.58-4.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e86(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e118(58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e14(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.40(0.96-\u0026nbsp;5.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e85(47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e95(52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e15(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e31(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.54(0.27-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSalt intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e39(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e112(74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e61(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12.51(6.30-\u0026nbsp;24.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e60(38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e98(62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eHypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e37(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e25(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.41(1.32-4.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3.96(1.33-11.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eHypertension\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e3(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.63(0.31-8.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.20(0.01-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eHeart Rate (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e29(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e113(79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eBradycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.79(0.68-88.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eTachycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e69(85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22.40(10.72-46.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eDuration of HFrEF (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eLess than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e90(74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMore than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e69(65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36(34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.56(3.13-9.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e4.60(1.76-11.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eNYHA class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eI\u0026amp;II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e25(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e81(76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eIII\u0026amp;IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e75(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e45(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.40(3.02-9.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eHospitalization within 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e30(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e94(75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e70(68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e32(31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.85(3.81-12.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3.31(1.42-7.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e26(27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e68(72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e74(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e58(44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.33(1.89-5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e6.36(2.28-17.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e67(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e106(61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e33(62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e20(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.61(1.38-\u0026nbsp;4.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Atrial \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e50(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e121(70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e50(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e24.20(9.11-\u0026nbsp;64.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Thyrotoxicosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e88(43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e117(57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e12(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e9(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.77(0.71-\u0026nbsp;4.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e80(39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e121(60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e20(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.05(2.18-16.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Dyslipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e68(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e116(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e32(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10(23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.45(2.52-11.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMedications\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; b-Blockers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e80(46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e92(53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.47(0.78-2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Diuretics \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; (furosemide)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e21(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e68(76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e79(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e58(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.41(2.43-7.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Antiplatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e48(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e86(64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e52(56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e40(43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.32(1.35-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp; Anticoagulants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e69(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e101(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31(55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e25(44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.81(0.98-3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eCreatinine, mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e39(28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e97(71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e61(67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e29(32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.23(2.93-9.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSerum sodium, mEq/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e109(77.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eHyponatremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e67(82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16.82(8.35-33.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eHypernatremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.34(0.37-14.65))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBaseline Echo LVEF class\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e37(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e63(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e63(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e20(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9.02(4.82-16.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3.12(1.29-7.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eLevel of HRQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eBetter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e33(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e94(74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e67(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e32(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.96(3.34-10.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e10.52(3.9-28.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anemia, quality of life, heart failure, reduced ejection fraction, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6856747/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6856747/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnemia is a frequent comorbidity in patients with heart failure and is associated with increased morbidity, mortality, and reduced quality of life. However, data on anemia prevalence, associated factors, and its prognostic significance are limited in our region. This study aimed to determine the prevalence of anemia in outpatients with heart failure with reduced ejection fraction, identify contributing factors, and evaluate its impact on quality of life at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted using an interviewer-administered questionnaire. Data collected included demographic, lifestyle, clinical, biochemical, and echocardiographic characteristics. Health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. Data were entered into EpiData 4.6 and analyzed using STATA 25. Bivariable and multivariable binary logistic regression analyses were performed to identify factors associated with anemia. Variables with a p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 in the multivariable analysis (based on AORs with 95% CIs) were considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 226 participants (mean age 51.12\u0026thinsp;\u0026plusmn;\u0026thinsp;13.17 years), the prevalence of anemia in heart failure with reduced ejection fraction patients was 44.2% (95% CI: 37.7\u0026ndash;51.0). Anemia was significantly associated with Age\u0026thinsp;\u0026ge;\u0026thinsp;50 years: AOR 4.18 (95% CI: 1.65\u0026ndash;10.58), Hypotension: AOR 3.96 (95% CI: 1.33\u0026ndash;11.75), HF duration\u0026thinsp;\u0026ge;\u0026thinsp;1 year: AOR 4.60 (95% CI: 1.76\u0026ndash;11.97), Recent hospitalization: AOR 3.31 (95% CI: 1.42\u0026ndash;7.67), Presence of comorbidities: AOR 6.36 (95% CI: 2.28\u0026ndash;17.76), Severely reduced ejection fraction: AOR 3.12 (95% CI: 1.29\u0026ndash;7.52), and Poor quality of life: AOR 10.52 (95% CI: 3.9\u0026ndash;28.36).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAnemia is highly prevalent among heart failure with reduced ejection fraction patients in this study and strongly associated with factors indicating advanced disease and comorbidity burden. Importantly, anemia is a significant predictor of poor Health-related quality of life. These findings highlight the need to recognize anemia as a key determinant of morbidity and reduced well-being in HFrEF patients.\u003c/p\u003e","manuscriptTitle":"Prevalence of Anemia, Its Associated Factors, and Impact on Quality of Life Among Heart Failure with Reduced Ejection Fraction Outpatients at the University of Gondar Hospital, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 12:40:48","doi":"10.21203/rs.3.rs-6856747/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-30T09:20:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T23:16:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T23:13:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133268509097785679761133742389120708298","date":"2025-06-29T14:09:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67082870419177085787327471296406923044","date":"2025-06-29T09:43:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118664000964678610657847004888557604404","date":"2025-06-29T01:41:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275614071189200398351606584082691773221","date":"2025-06-28T22:37:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-28T22:30:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-28T22:17:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-19T07:30:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-18T18:54:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-06-18T18:50:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"22e5975b-5bb2-4eed-9267-7da9b68910d0","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:43:58+00:00","versionOfRecord":{"articleIdentity":"rs-6856747","link":"https://doi.org/10.1186/s12872-025-05039-2","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-07-31 16:05:46","publishedOnDateReadable":"July 31st, 2025"},"versionCreatedAt":"2025-06-24 12:40:48","video":"","vorDoi":"10.1186/s12872-025-05039-2","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05039-2","workflowStages":[]},"version":"v1","identity":"rs-6856747","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6856747","identity":"rs-6856747","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}