Objectives This study sought to determine the characteristics and long-term prognosis of anemia in ambulatory patients with chronic heart failure. Background Anemia is prevalent in heart failure, and may portend poor outcomes. Methods We reviewed 6,159 consecutive outpatients with chronic stable heart failure at baseline, short-term (3-month) follow-up, and long-term (6-month) follow-up between 2001 and 2006. Clinical, demographic, laboratory, and echocardiographic data were reviewed from electronic medical records. Mortality rates were determined from 6-month follow-up to end of study period. Results Prevalence of anemia (hemoglobin [Hb] <12 g/dl for men, <11 g/dl for women) was 17.2% in our cohort. Diabetes, B-natriuretic peptide, left ventricular ejection fraction, and estimated glomerular filtration rate were independent predictors of baseline anemia. Documented evaluation of anemia was found in only 3% of all anemic patients, and better in internal medicine than in cardiology clinics. At 6-month follow-up, new-onset anemia developed in 16% of patients without prior anemia, whereas 43% patients with anemia at baseline had resolution of their hemoglobin levels. Higher total mortality rates were evident in patients with persistent anemia (58% vs. 31%, p < 0.0001) or with incident anemia (45% vs. 31%, p < 0.0001) compared with those with without anemia at 6 months. Conclusions These observations in a broad unselected outpatient cohort suggest that anemia in patients with heart failure is under-recognized and underevaluated. However, resolution of anemia was evident in up to 43% of patients who presented initially with anemia, and did not pose greater long-term risk for all-cause mortality. However, the presence of persistent anemia conferred poorest survival in patients with heart failure when compared with that of incident, resolved, or no anemia.