Iron deficiency is a key determinant of health‐related quality of life in patients with chronic heart failure regardless of anaemia status

Comín‐Colet, Josep; Enjuanes, Cristina; Gonzalez, Gina; Torrens, Ainhoa; Cladellas, Mercè; Meroño, Oona; Ribas, Núria; Ruiz, Sonia; Gómez, Miquel; Verdú, José María; Bruguera, Jordi

doi:10.1093/eurjhf/hft083

Cited by 180 publications

(187 citation statements)

References 25 publications

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“…Prevalence rates of iron deficiency (ID) in Southeast Asian HF patients also exceed those in European patients, averaging 61% and peaking at 80% in patients of Indian ethnicity 3. Regardless of ethnicity, geographical location, and anaemia status, concurrent HF and ID has consistently been associated with poor outcomes such as reduced exercise capacity, reduced quality of life (QoL), and elevated risks of HF hospitalization and mortality 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Yeo

Hadi³

et al. 2018

ESC Heart Failure

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AimsIron deficiency is highly prevalent in Southeast Asians with heart failure (HF) and associated with worse outcomes. This trial aimed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF.Methods and resultsFifty patients hospitalized for acute decompensated HF, regardless of ejection fraction, with iron deficiency (defined as serum ferritin <300 ng/mL if transferrin saturation is <20%) were randomized to receive either one dose of intravenous ferric carboxymaltose (FCM) 1000 mg or placebo (0.9% saline) following HF stabilization and before discharge in two Singapore tertiary centres. The primary endpoint was difference in 6‐min walk test (6MWT) distance over 12 weeks, while secondary endpoints were quality of life assessed using validated Kansas City Cardiomyopathy Questionnaire (KCCQ) and Visual Analogue Scale (VAS). Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups (from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m, respectively). Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo, but adjustment for baseline covariates and time attenuated this effect {adjusted mean difference between groups: 0.88 m [95% confidence interval (CI) −30.2 to 32.0, P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [adjusted mean difference: KCCQ −1.48 (95% CI −8.27 to 5.31, P = 0.670) and VAS 0.26 (95% CI −0.33 to 0.86, P = 0.386)]. FCM was well tolerated with no serious treatment‐related adverse events.ConclusionsIntravenous FCM administered pre‐discharge in Southeast Asians hospitalized with decompensated HF is clinically feasible. Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects.

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Section: Introductionmentioning

confidence: 99%

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Yeo

Hadi³

et al. 2018

ESC Heart Failure

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“…Less obvious interactions are the presumed direct promoting effect of FGF-23 on cardiomyocyte hypertrophy [17] and the anemia-independent worsening effect of iron deficiency on heart function [18]. Our results argue for an association between the bone mineral axis and iron metabolism.…”

Section: Discussionmentioning

confidence: 72%

Characterization of an Animal Model to Study Risk Factors and New Therapies for the Cardiorenal Syndrome, a Major Health Issue in Our Aging Population

2017

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Background: The cardiorenal syndrome (CRS) is a major health problem in our aging population. The term was introduced to cover disorders of the kidneys and heart, whereby dysfunction of one organ may induce dysfunction of the other. As the natural history of the CRS is mostly slow, hence difficult to explore in clinical trials, adequate animal models combining cardiovascular and renal disease are required. Therefore, we developed and characterized a usable model for CRS type 4, i.e. chronic kidney disease (CKD) causing cardiac dysfunction. Methods: CKD was induced in rats by supplementing the diet with adenine. During 8 weeks, several aspects of CRS were studied: CKD, mineral-bone disorder (MBD), cardiovascular disease, and (iron-deficiency) anemia. Hereto, the following parameters were monitored: serum creatinine, calcium, phosphate, FGF23, dynamic bone parameters, aortic Ca deposits, heart weight, serum NT-proANP, Hct, Hb, reticulocytes, spleen iron, and serum hepcidin. Results: Animals developed a severe CKD together with a disturbed mineral balance as reflected by the increased serum creatinine and phosphorus levels and decreased serum calcium levels; and in association herewith aberrations in hormonal levels of FGF-23. In turn, the well-known and highly undesirable complications of CKD, i.e. high turnover bone disease and pathological vessel calcification were induced. Furthermore (iron-deficiency) anemia developed quickly. Conclusion: The animal model described in this article in many aspects mimics the human situation of the CRS type 4 and will be useful to concomitantly evaluate the effects of new treatment strategies on the various aspects of CRS.

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“…Several studies have demonstrated that patients with HFpEF with iron deficiency suffered from a similar impact on health-related QoL as patients with HFrEF [17, 28]. Moreover, in both HFrEF and HFpEF, concomitant iron deficiency informs for all-cause mortality independent of the presence or absence of anemia [29].…”

Section: Iron In Diastolic Hfmentioning

confidence: 99%

Management of Iron Deficiency in Heart Failure

2019

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Anemia is a common finding in patients with heart failure (HF). The cause for anemia is multifactorial, with iron deficiency being the most common cause. Anemia with HF is an established predictor of morbidity and mortality. Iron deficiency in systolic HF, even without anemia, has been associated with increased mortality, increased hospitalizations, and decreased functional capacity and quality of life measures. Data from several randomized controlled trials and meta-analyses of iron deficiency and systolic HF show a beneficial effect for intravenous (IV) iron in terms of quality of life and functional capacity (improvements in 6-min walk test, and improvements in New York Heart Association functional class), as well as decreased hospitalizations for HF and reduction in cardiovascular mortality rates. Limited evidence exists for a beneficial effect of IV iron in diastolic dysfunction. Patients with symptomatic systolic HF should undergo an anemia diagnostic work-up. When iron deficiency (defined as ferritin <100 ng/mL or serum ferritin 100–299 ng/mL and transferrin saturation <20%) is present, current evidence supports treating HF patients with iron deficiency with IV iron.

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Iron deficiency is a key determinant of health‐related quality of life in patients with chronic heart failure regardless of anaemia status

Cited by 180 publications

References 25 publications

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Characterization of an Animal Model to Study Risk Factors and New Therapies for the Cardiorenal Syndrome, a Major Health Issue in Our Aging Population

Management of Iron Deficiency in Heart Failure

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