Anemia is common in hospitalized cardiac patients and affects prognosis. Even moderate levels of anemia can be associated with high cardiovascular mortality when compared to normal hemoglobin levels in cases of patients with acute decompensated heart failure. Background: Anemia is a comorbidity potentially treatable, with significant prognostic implications. A restrictive transfusion is triggered by hemoglobin is ≤8g/dl (severe anemia) and a liberal transfusion is considered when hemoglobin ≤10 g/dL. Methods: We perform a retrospective analysis of the patients hospitalized in the Cardiology Department of Constanta County Hospital who required blood derivatives transfusions, between 1st of January 2021 - 31st of December 2021. Results: Out of the total 270 patients, 170 received a single unit of resuspended erythrocyte concentrate within the same month, while 100 required multiple transfusions, receiving between 2 and 5 units during a single hospitalization to correct anemia. Before transfusions, the mean hemoglobin (Hb) level was 7.60 g/dl, with values ranging from 6.50 g/dl to 9.10 g/dl. Men show a higher prevalence (64%) than women (36%), likely due to gender differences in susceptibility to heart conditions. After transfusions, the mean Hb reached 10.05 g/dl (minimum/maximum values of 7.40 and 12.70 g/dl). CKD patients consistently experience higher in-hospital mortality across LVEF sub-groups, while CRS patients have relatively lower mortality rates, with significant associations observed between reduced LVEF and increased mortality across all patient groups. Conclusions: Anemia in heart failure patients is linked to worsening symptoms, including decreased exercise tolerance, increased cardiovascular events, decreased kidney function and higher hospitalization and mortality rates, especially in those with associated acute or chronic kidney failure. The findings aim to inform and optimize clinical decision making, particularly regarding transfusion strategies and risk management in this high-risk population.