Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Abstract

Summary Frank iron deficiency has been associated with a wide range of cardiac and pulmonary abnormalities including non‐ischaemic cardiomyopathy. Iron deficiency anaemia and isolated iron deficiency are well‐defined adverse prognostic factors in non‐ischaemic cardiac failure. Furthermore, iron‐deficient patients in chronic heart failure with a serum ferritin of <100 μg/l or <300 μg/l with reduced transferrin saturation of <20%, who were given intravenous iron showed improved clinical outcomes. Iron deficiency with or without anaemia affects over a quarter of the world's population, but the impact of iron deficiency in heart failure and the effective management of iron deficiency in heart failure in Lower and Middle Income Countries (LMICs) is not well described. Heart failure in African cohorts occurs at a younger age than in North America and Europe and is more likely to be due to hypertension. Recent studies suggest that iron deficiency anaemia, which is very common in heart failure patients in Africa, and iron deficiency are independently associated with a poor prognosis in heart failure. Preliminary data suggest that iron deficiency in patients with heart failure can be treated with oral iron, with significant beneficial effects on haematological and physiological variables. Cost may prohibit the use of intravenous iron on a large scale in LMICs and optimal regimes to treat iron deficiency in heart failure patients with oral iron therapy remain to be defined.

The Cardiomyopathy of Iron Deficiency Anaemia

“…21 In nonischaemic cardiac failure, IDA is a well-defined adverse prognostic factor. 4,12,22,23 These study findings indicate that IDA plays a significant role in the function of the heart. In addition, the myocardium is a key factor in the pathophysiology of heart failure.…”

“…24,25 Anaemia and ID are common causes of heart failure, both separately and in combination. 22 Honda et al 14 showed that anaemia was an independent predictor of myocardial damage or subclinical myocardial damage and cardiovascular mortality in the general population. Current evidence suggests that ID and anaemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as in those with heart failure and preserved ejection fraction.…”

Trends of Cardiovascular Mortality in Blacks Africans from Central African City: Hospital Based Study, Brazzaville (Congo)

“…Anemia is often reported in patients with heart failure (15.2%) in sub-Saharan Africa [7]. Anemia is associated with iron deficiency, requiring long-term treatment and multidisciplinary team supervision [14]. In Africa, in terms of living conditions and the lack of care, the prognosis in this context is poor [14].…”

“…-Anemia: hemoglobin < 12 g/dL in men, and <13 g/dL in women, or less than 2 units of usual value [14].…”

Serum iron levels are an independent predictor of in-hospital mortality of critically ill patients: a retrospective, single-institution study

“…2 Serum iron levels are one of the most commonly measured markers in critically ill patients. Serum iron levels are closely associated with anemia, 6 severity of infection, 7 and cardiac failure, 8 all of which are common complications in critically ill patients and may affect the prognosis of patients. This retrospective, single-center study aimed to determine the relationship between serum iron levels and in-hospital mortality of critically ill patients in the ICU.…”