Iron Deficiency Status Irrespective of Anemia: A Predictor of Unfavorable Outcome in Chronic Heart Failure Patients

Abstract

Objective: To assess the prognostic significance of iron deficiency (ID) in a chronic heart failure (CHF) outpatient population. Methods and Results: We prospectively evaluated 127 patients with stable CHF and left ventricular ejection fraction ≤45%. Clinical and analytical data as well as information regarding the occurrence of the composite endpoint of overall mortality and nonfatal cardiovascular events were assessed. Among the 127 patients enrolled [81% men, median age: 62 years (25th-75th percentile: 53-68)], 46 (36%) patients had ID. Women, patients with higher plasma brain natriuretic peptide levels (>400 pg/ml) and with right ventricular systolic dysfunction presented ID more frequently (p < 0.05 for all). At 225 ± 139 days of follow-up, the composite endpoint occurred in 15 (12%) patients. It was more frequent in ID (24 vs. 5%, p = 0.001) and anemic patients (25 vs. 8%, p = 0.014). In a Cox regression analysis, ID was associated with a higher likelihood of composite endpoint occurrence (HR 5.00, 95% CI 1.59-15.78, p = 0.006). In a multivariable analysis adjusted for clinical variables, including the presence of anemia, ID remained a significant predictor of the composite endpoint (HR 5.38, 95% CI 1.54-18.87, p = 0.009). Conclusion: In a CHF outpatient population, ID carried a higher risk of unfavorable outcome, irrespectively of the presence of anemia.

Iron Therapy in Patients with Heart Failure and Iron Deficiency: Review of Iron Preparations for Practitioners

“…Based on laboratory tests (the only study investigating ID in HF based on bone marrow aspirates is presented in Table 1), the prevalence of ID in HF ranges from 33 to 74% [14, 23, 24, 26, 45–53], with higher rates in anaemics versus non-anaemics [14, 23, 24, 26, 45, 48, 49] and decompensated [26, 52, 54, 55] versus stable HF [14, 23, 24, 45–51, 53, 56–58] (Table 1). …”

“…The majority of data on the prevalence of ID in HF comes from European HFrEF cohorts [14, 24, 48, 50, 56]; however, the limited data on patients with both reduced and preserved left ventricle ejection fraction (HFpEF) show similar percentages of iron-deficient enrolees [23, 46]. Importantly, in one study involving a multi-ethnic Southeast Asian population of patients with HF, the prevalence of ID was higher than in European cohorts [23, 26, 49, 55].…”

Anemia in Intensive Cardiac Care Unit patients – An underestimated problem

“…442 Not only anemia but also other parameters may reflect the 443 severity of HF and future prognosis. Iron deficiency, defined as 444 depleted body iron stores and high-serum soluble transferrin 445 receptor, is common in both acute and chronic HF, and identifies 446 patients with poor outcome, independently of Hb level [61,62]. Red 447 blood cell distribution width (RDW), a measure of the variability in 448 the size of circulating erythrocytes can be used in the classification of 449 anemia.…”

The Efficacy and Safety of Iron Supplementation in Patients With Heart Failure and Iron Deficiency: A Systematic Review and Meta-analysis

“…4 ID, with or without anemia, is associated with exercise intolerance, low quality of life, and increased mortality and hospitalization in patients with HF. [5][6][7] Besides improving erythropoiesis, intravenous iron has been shown to maintain energy metabolism by augmenting aerobic metabolism and oxidative phosphorylation. 8 Cells with high-energy demand, such as cardiomyocytes and skeletal myocytes, are particularly sensitive to ID.…”