Iron Deficiency in Heart Failure

Haehling, Stephan von; Ebner, Nicole; Evertz, Ruben; Ponikowski, Piotr; Anker, Stefan D.

doi:10.1016/j.jchf.2018.07.015

Cited by 230 publications

(234 citation statements)

References 30 publications

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“…Patients with chronic heart failure are likely to also have comorbid iron deficiency anemia, and the administration of iron preparations can improve prognoses. 27 Thus, a large proportion of patients who are prescribed diuretics might have chronic heart failure accompanied by chronic diseases, such as hyperuricemia and atrial fibrillation. This could explain the higher likelihood of polypharmacy in these patients.…”

Section: Discussionmentioning

confidence: 99%

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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Aim To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. Methods Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. Results A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation‐related drugs, insomnia/anxiety‐related drugs, pain‐related drugs, lifestyle disease‐related drugs and dementia‐related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. Conclusions Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304–311.

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Section: Discussionmentioning

confidence: 99%

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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“…[58][59][60] Ferric carboxymaltose improves functional capacity, symptoms, and quality of life of HF patients with iron deficiency. 45,62 63 Ongoing trials are aimed at showing the impact of iron therapy on outcomes, including mortality.…”

Section: Treatment Of Iron Deficiencymentioning

confidence: 99%

“…63 Ongoing trials are aimed at showing the impact of iron therapy on outcomes, including mortality. 45,62…”

Section: Treatment Of Iron Deficiencymentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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“…ID is common feature in patients with HF not caused by iron‐overload cardiomyopathy . It predicts poor exercise capacity, quality of life and survival .…”

Section: Role Of Iron In Heart Diseasementioning

confidence: 99%

“…ID is common feature in patients with HF not caused by iron‐overload cardiomyopathy . It predicts poor exercise capacity, quality of life and survival . This has created the need to evaluate the role of iron supplementation in treatment of HF .…”

Section: Role Of Iron In Heart Diseasementioning

confidence: 99%

Keeping heart homeostasis in check through the balance of iron metabolism

Vela

2019

Acta Physiologica

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Highly active cardiomyocytes need iron for their metabolic activity. In physiological conditions, iron turnover is a delicate process which is dependent on global iron supply and local autonomous regulatory mechanisms. Though less is known about the autonomous regulatory mechanisms, data suggest that these mechanisms can preserve cellular iron turnover even in the presence of systemic iron disturbance.Therefore, activity of local iron protein machinery and its relationship with global iron metabolism is important to understand cardiac iron metabolism in physiological conditions and in cardiac disease. Our knowledge in this respect has helped in designing therapeutic strategies for different cardiac diseases. This review is a synthesis of our current knowledge concerning the regulation of cardiac iron metabolism. In addition, different models of cardiac iron dysmetabolism will be discussed through the examples of heart failure (cardiomyocyte iron deficiency), myocardial infarction (acute changes in cardiac iron turnover), doxorubicin-induced cardiotoxicity (cardiomyocyte iron overload in mitochondria), thalassaemia (cardiomyocyte cytosolic and mitochondrial iron overload) and Friedreich ataxia (asymmetric cytosolic/mitochondrial cardiac iron dysmetabolism). Finally, future perspectives will be discussed in order to resolve actual gaps in knowledge, which should be helpful in finding new treatment possibilities in different cardiac diseases. K E Y W O R D Scardiomyocyte, heart failure, iron chelation, iron metabolism, mitochondria, transferrin receptor 1

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Iron Deficiency in Heart Failure

Cited by 230 publications

References 30 publications

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Highlights in heart failure

Keeping heart homeostasis in check through the balance of iron metabolism

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