Anemia and iron deficiency in patients with atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia and has a rising global prevalence. Given the increasing burden of AF-related symptoms and complications, new approaches to management are required. Anemia and iron deficiency are common conditions in patients with AF. Furthermore, emerging evidence suggests that the presence of anemia may be associated with worse outcome in these patients. The role of anemia and iron deficiency has been extensively explored in other cardiovascular states, such as heart failure and ischemic heart disease. In particular, the role of iron repletion amongst patients with heart failure is now an established treatment modality. However, despite the strong bidirectional inter-relationship between AF and heart failure, the implications of anemia and iron-deficiency in AF have been scarcely studied. This area is of mechanistic and clinical relevance given the potential that treatment of these conditions may improve symptoms and prognosis in the increasing number of individuals with AF. In this review, we summarise the current published literature on anemia and iron deficiency in patients with AF. We discuss AF complications such as stroke, bleeding, and heart failure, in addition to AF-related symptoms such as exercise intolerance, and the potential impact of anemia and iron deficiency on these. Finally, we summarize current research gaps on anemia, iron deficiency, and AF, and underscore potential research directions.

Iron deficiency and cardiovascular disease

“…Evidence on epidemiology and prognostic role of ID in atrial fibrillation (AF) is very limited. 95 In the National Inpatient Sample database, 2.5% of patients with a primary AF hospitalization had ID, which was associated with higher rates of acute myocardial infarction, use of vasopressors and mechanical ventilation, longer hospital stay and acute kidney injury, but not of mortality or cardiogenic shock. 96 In 127 patients with AF and without HF, 47.6% had ID defined according to the ESC HF guidelines definition, whereas prevalence was 20% in an age- and gender-matched control population.…”

Iron and atrial fibrillation: A review

“…The prevalence of AF and anemia is increasing as the population ages. 53 Patients with AF have a high potential for concomitant anemia. 54 As easily as AF is found in the elderly people, the incidence of anemia is higher in the elderly people.…”

“…Anemia is widespread in various heart diseases whose mechanism is mostly due to iron deficiency. The prevalence of AF and anemia is increasing as the population ages 53 . Patients with AF have a high potential for concomitant anemia 54 .…”

Antiaggreganti piastrinici e anticoagulanti: le competenze dell’internista

“…31 In una recente meta-analisi che ha incluso tutti i dati disponibili da trial randomizzati su pazienti anziani, emerge che l'uso di clopidogrel è associato alla massima probabilità di riduzione degli eventi di sanguinamento; tuttavia, è il prasugrel (anche utilizzato al dosaggio di 5 mg/die) ad avere la maggiore probabilità di riduzione di eventi ischemici. 32 È necessario, perciò, in questi pazienti raccomandare durata e composizione di DAPT sulla base del rischio ischemico ed emorragico rilevato, 33 mentre una alternativa potrebbe essere rappresentata dall'utilizzo di strategie di 'de-escalation' (discusse in seguito).…”

“…Infine, in una recente meta-analisi di 8 studi, 228,497 pazienti totali con FA e cancro attivo o storia di cancro in terapia con DOAC o warfarin, i DOAC hanno mostrato un miglior profilo di efficacia (log incidence rate -0,38 (P=0,008) e sicurezza (log incidence rate -0.43 (P<0,005) rispetto al warfarin. 33 -Paziente con Insufficienza renale: Tra i fattori che aumentano il rischio di sviluppare FA, oltre all'età, diabete mellito, ipertensione arteriosa e cardiopatia ischemica è compresa l'insufficienza renale cronica (IRC). 34 La IRC si associa adipertensione arteriosa, ipertrofia ventricolare sinistra, infiammazione e fibrosi atriale (per effetto dell'attivazione protratta del sistema renina-angiotensina-aldosterone 35 ), fattori potenzialmente associati ad aumentato rischio di FA.…”