The aim of this study was to assess the impact of anemia on the clinical outcomes of chronic heart failure (CHF) by a meta-analysis and systemic review of published literatures. Twenty published English-language articles were selected from Medline, PubMed, and ISI Database. Clinical data were extracted, pooled, and analyzed with a fixed- or random-effects model. A total of 97,699 patients with CHF were identified from the published studies. Meta-analysis of these studies indicated that anemia is associated with a higher risk for death (relative risk [RR], 1.66; P<.0001). In addition, anemic patients had more advanced New York Heart Association class (III or IV; RR, 1.35; P<.0001) and lower left ventricular ejection fraction (weight mean difference, -0.53; P<.0001) than nonanemic patients. Systemic review also revealed that the severity of anemia is closely related to the rate of mortality and hospitalization for heart failure. Anemia is associated with an increased risk of mortality and rate of hospitalization for heart failure. Anemia is an independent risk factor for adverse outcomes in patients with CHF.