Natural history and prognostic significance of iron deficiency and anaemia in ambulatory patients with chronic heart failure. (1st July 2021)

• Record Type: Journal Article
• Authors: Graham, Fraser J.; Masini, Gabriele; Pellicori, Pierpaolo; Cleland, John G.F.; Greenlaw, Nicola; Friday, Jocelyn; Kazmi, Syed; Clark, Andrew L.
• Is Part Of: European journal of heart failure. Volume 24:Number 5(2022)
• Page Start: 807
• Page End: 817
• Publication Date: 2021-07-01
• Subjects: Iron deficiency -- Anaemia -- Heart failure -- Natural history; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2251
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. Methods and results: We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65–79) years, 70% men, 51% with heart failure with reduced ejection fraction) 1 year apart. ID was defined as serum iron ≤13 µmol/L and anaemia as haemoglobin <13.0 g/dL for men or <12.0 g/dL for women. FAIR‐HF criteria for ID were also considered. At baseline, 10% had anaemia without ID, 23% had ID without anaemia, 20% had both, and 47% had neither. Percentages changed little over 1 year, but 157 (30%) patients had new‐onset ID, 104 (16%) new‐onset anaemia, whilst ID resolved in 173 (44%) and anaemia in 63 (23%). Compared to those who remained iron replete (iron >13 µmol/L), mortality was higher in those with persistent or incident ID at 1 year [hazard ratio (HR) 1.81 (1.23–2.67), and HR 1.40 (0.91–2.14), respectively] in multivariable models ( P = 0.02). Compared to persistent ID, resolution of ID was associated with a lower mortality [HR 0.61 (0.44–0.86); P = 0.004]. Changes in ID defined by FAIR‐HF criteria were not similarly associated with mortality. Anaemia was associated with a poor outcome even if it resolved. Conclusions: The prevalence and incidence of ID and anaemia are high in chronic heart failure but so is the rate of resolution. Persistent or incident ID, defined by a serum iron ≤13 µmol/L, is associated with higher mortality and resolution of ID with lower mortality. Abstract : Longitudinal data from 906 patients with chronic heart failure. Over 1 year most patients (70%) have or develop iron deficiency (ID), anaemia or both. Compared to those with either persistent ID or anaemia, only those who recovered from ID (achieving a serum iron >13 µmol/L) had lower all‐cause mortality at 4 years, with transferrin saturation (TSAT) showing a similar trend. CI, confidence interval; HR, hazard ratio.