The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure

Ebner, Nicole; Jankowska, Ewa A.; Ponikowski, Piotr; Lainščak, Mitja; Elsner, Sebastian; Sliziuk, Veronika; Steinbeck, Lisa; Kube, Jennifer; Bekfani, Tarek; Scherbakov, Nadja; Valentová, Miroslava; Sandek, Anja; Doehner, Wolfram; Springer, Jochen; Anker, Stefan D.; Haehling, Stephan von

doi:10.1016/j.ijcard.2015.11.178

Cited by 110 publications

(99 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings from the PrEP registry regarding ID prevalence are thus in accordance with published data from several clinical cohorts as well as from smaller outpatient cohorts. The PrEP results also correspond to a recent report from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF): [18]. Among outpatients with systolic HF, 30% presented with anaemia and 45% with ID.…”

Section: Discussionsupporting

confidence: 84%

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

Haehling

Gremmler²,

Krumm³

et al. 2017

Clin Res Cardiol

Self Cite

101

View full text Add to dashboard Cite

BackgroundIron deficiency (ID) and anaemia are common in heart failure (HF). The prospective, observational PReP registry (Prävalenz des Eisenmangels bei Patienten mit Herzinsuffizienz) studied prevalence and clinical impact of ID and anaemia in HF outpatients attending cardiology practices in Germany.Methods and resultsA total of 42 practices enrolled consecutive patients with chronic HF [left ventricular ejection fraction (LVEF) ≤45%]. ID was defined as serum ferritin <100 µg/l, or serum ferritin ≥100 µg/l/<300 µg/l plus transferrin saturation <20%, and anaemia as haemoglobin <13 g/dl (12 g/dl) in men (women). Exercise capacity was assessed using spiroergometry (69.4%) or 6-min walk test (30.4%). Amongst 1198 PReP-participants [69.0 ± 10.6 years, 25.3% female, New York Heart Association (NYHA) class 2.4 ± 0.5, LVEF 35.3 ± 7.2%], ID was found in 42.5% (previously unknown in all), and anaemia in 18.9% (previously known in 4.8%). ID was associated with female gender, lower body weight and haemoglobin, higher NYHA class and natriuretic peptide (NP) levels (all p < 0.05). ID was also more common in anaemic than non-anaemic patients (p < 0.0001), and 9.8% of PrEP-participants had both, ID and anaemia. On spiroergometry, ID independently predicted maximum exercise capacity even after multivariable adjustment, including anaemia (p = 0.0004). In all PrEP-participants, ID predicted reduced physical performance (adjusted for age, gender, anaemia, serum creatinine, C-reactive protein, LVEF, and NP level).ConclusionsDespite high prevalence, ID was previously unknown in all PrEP-participants, and anaemia was often unappreciated. Given the clinical relevance, treatability, and independent association with reduced physical performance, ID should be considered more in real-world ambulatory healthcare settings and ID-screening be advocated to cardiologists in such populations.

show abstract

Section: Discussionsupporting

confidence: 84%

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

Haehling

Gremmler²,

Krumm³

et al. 2017

Clin Res Cardiol

Self Cite

101

View full text Add to dashboard Cite

show abstract

“…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). …”

Section: Prevalence Of Id In Hfmentioning

confidence: 99%

“…In patients with HFrEF, ID is associated with impaired aerobic performance, as reflected by lower peak oxygen consumption (VO 2 ), higher ventilatory response to exercise (VE-VCO 2 slope) [14, 51, 59], and lower 6-min walk test (6MWT) distance [51]. Importantly, in patients with HFrEF, the impact of ID on both peak VO 2 and VE-VCO 2 slope is independent of and much stronger than the effect of anaemia alone [59].…”

Section: Clinical Consequences Of Id In Hfmentioning

confidence: 99%

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

Drozd

Jankowska

Banasiak³

et al. 2016

Am J Cardiovasc Drugs

Self Cite

View full text Add to dashboard Cite

In patients with heart failure (HF), iron deficiency (ID) correlates with decreased exercise capacity and poor health-related quality of life, and predicts worse outcomes. Both absolute (depleted iron stores) and functional (where iron is unavailable for dedicated tissues) ID can be easily evaluated in patients with HF using standard laboratory tests (assessment of serum ferritin and transferrin saturation). Intravenous iron therapy in iron-deficient patients with HF and reduced ejection fraction has been shown to alleviate HF symptoms and improve exercise capacity and quality of life. In this paper, we provide information on how to diagnose ID in HF. Further we discuss pros and cons of different iron preparations and discuss the results of major trials implementing iron supplementation in HF patients, in order to provide practical guidance for clinicians on how to manage ID in patients with HF.

show abstract

“…In addition to the economic burden, IDA can negatively impact a patient's daily functioning and mental health. Indeed, several studies report that people with anemia have a reduced ability to exercise as well a reduced quality of life vs those without anemia …”

Section: Discussionmentioning

confidence: 99%

“…Iron deficiency anemia can be associated with burdensome clinical symptoms, such as fatigue, dyspnea, headaches, paleness, and vertigo . IDA can also have far‐reaching consequences, affecting cognitive function, reducing the ability to exercise, and worsening comorbid diseases (e.g., chronic kidney disease [CKD] and inflammatory bowel disease [IBD]) . Analysis of patient‐reported outcome surveys demonstrated that people with anemia also have a reduced quality of life versus those without anemia …”

mentioning

confidence: 99%

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

LaVallee¹,

Cronin²,

Bansal³

et al. 2019

Pharmacotherapy

View full text Add to dashboard Cite

Study Objective Iron deficiency anemia is the most common form of anemia, and parenteral iron therapy is necessary in select patients. The objective of this analysis was to assess the impact of initial complete parenteral iron repletion on serum hemoglobin (Hgb) level normalization and on health care resource utilization in real‐world practice. Design Retrospective observational study. Data Source Decision Resources Group Real‐World Data Repository (United States databases). Patients A total of 2966 patients who had a baseline Hgb level below normal (< 12 g/dl for females and < 13.5 g/dl for males) and were treated with parenteral iron between March 2015 and February 2017. Measurements and Main Results The effect of receiving the required parenteral iron dose to replete the deficit, calculated by a modified Ganzoni formula, within 3 weeks of the first parenteral iron therapy claim (index date) on the likelihood of Hgb level normalization, was estimated by using logistic regression. All analyses were adjusted for sex, age, comorbidities, and use of prescription oral iron therapy. The adjusted mean numbers of all‐cause inpatient admissions, outpatient visits, and emergency department (ED) visits within 6 months and 1 year after the index date were compared between patients with and without normalized Hgb levels by using negative binomial regression. Of the 2966 included patients, 33.9% received the required iron dose within 3 weeks of the index date, and 19.6%, 48.2%, and 53.9% had a normalized Hgb level within 8 weeks of the index date, within 1 year of the index date, and until the end of data availability, respectively. Patients who received the required iron dose within 3 weeks of the index date were significantly more likely to have a normalized Hgb level within 8 weeks of the index date and at any time during the study period than those who did not: adjusted odds ratio (OR) (95% confidence interval [CI]) 2.67 (2.20, 3.24) and 2.33 (1.96, 2.77), respectively. Hgb level normalization within 1 year of the index date was associated with fewer inpatient admissions and outpatient visits and a similar number of ED visits compared with no Hgb level normalization 1 year after the index date. Conclusion The results of these analyses underscore the importance of initial complete parenteral iron repletion for rapidly improving clinical outcomes. Prompt achievement of a normalized Hgb level may also provide an opportunity to reduce health care resource utilization in patients with iron deficiency anemia receiving parenteral iron therapy.

show abstract

The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure

Cited by 110 publications

References 31 publications

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

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

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

Contact Info

Product

Resources

About