Expert consensus on the importance of iron deficiency and the possibility of its correction in patients with heart failure

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms. It is, therefore, reasonable to screen for and treat ID in patients with HF.

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Monitoring of iron status in patients with heart failure

European Heart Journal Supplements ◽

10.1093/eurheartj/suz231 ◽

2019 ◽

Vol 21 (Supplement_M) ◽

pp. M32-M35 ◽

Cited By ~ 2

Author(s):

Ewa A Jankowska ◽

Michał Tkaczyszyn ◽

Marcin Drozd ◽

Piotr Ponikowski

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Serum Ferritin Level ◽

Iron Status ◽

Ferritin Level ◽

Transferrin Saturation ◽

Intravenous Iron ◽

Accurate Method ◽

Separate Entity ◽

Patients With Heart Failure

Abstract The 2016 ESC/HFA heart failure (HF) guidelines emphasize the importance of identifying and treating iron deficiency (ID) in patients with HF. Iron deficiency can occur in half or more of HF sufferers, depending on age and the phase of the disease. Iron deficiency can be a cause of anaemia, but it is also common even without anaemia, meaning that ID is a separate entity, which should be screened for within the HF population. Although assessment of iron stores in bone marrow samples is the most accurate method to investigate iron status, it is not practical in most HF patients. Levels of circulating iron biomarkers are an easily available alternative; especially, ferritin and transferrin saturation (Tsat). In patients with HF serum ferritin level <100 µg/L (regardless of Tsat value) or between 100 and 299 µg/L with Tsat <20% are considered as recommended criteria for the diagnosis of ID, criteria which have been used in the clinical trials in HF that have led to a recommendation to treat ID with intravenous iron. We discuss the optimal measures of iron biomarkers in patients with HF in order to screen and monitor iron status and introduce some novel ways to assess iron status.

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Prevalence and pattern of Iron deficiency in patient with heart failure with reduced ejection fraction

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i2.30689 ◽

2019 ◽

Vol 7 (2) ◽

pp. 10-16

Author(s):

Aditya Mahaseth ◽

Jay Narayan Shah ◽

Bikash Nepal ◽

Biplave Karki ◽

Jeet Ghimire ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Functional Iron Deficiency ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Absolute Iron Deficiency

Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia. Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency. Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.

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Impact of iron deficiency on long-term clinical outcomes of hospitalized patients with heart failure

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.03.039 ◽

2018 ◽

Vol 261 ◽

pp. 114-118 ◽

Cited By ~ 9

Author(s):

Hiroki Nakano ◽

Toshiyuki Nagai ◽

Varun Sundaram ◽

Michikazu Nakai ◽

Kunihiro Nishimura ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Clinical Outcomes ◽

Hospitalized Patients ◽

Patients With Heart Failure

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Iron deficiency in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Open Heart ◽

10.1136/openhrt-2019-001012 ◽

2019 ◽

Vol 6 (1) ◽

pp. e001012 ◽

Cited By ~ 13

Author(s):

Anna L Beale ◽

Josephine Lillian Warren ◽

Nia Roberts ◽

Philippe Meyer ◽

Nick P Townsend ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Meta Analysis ◽

Conclusive Evidence ◽

Preserved Ejection Fraction ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Related Quality ◽

Health Related

ObjectiveIron deficiency (ID) has an established impact on outcomes in patients with heart failure with reduced ejection fraction; however, there is a lack of conclusive evidence in patients with heart failure with preserved ejection fraction (HFpEF). We sought to clarify the prevalence and impact of ID in patients with HFpEF.MethodsA systematic search of Cohcrane, MEDLINE, EMBASE, Web of Science and CINAHL electronic databases was performed to identify relevant studies. Included studies defined HFpEF as heart failure with an ejection fraction ≥50%. We used a random-effects meta-analysis to determine the composite prevalence of ID in patients with HFpEF across the included studies. Other outcomes were assessed with qualitative analysis due to a paucity of studies with comparable outcome measures.ResultsThe prevalence of ID in the included studies was 59% (95% CI 52% to 65%). ID was associated with lower VO2 max in three of four studies reporting VO2 max as an outcome measure, lower functional status as determined by dyspnoea class or 6 min walk test in two of three studies, and worse health-related quality of life in both studies reporting on this outcome. Conversely, ID had no impact on death or hospitalisation in three of the four studies investigating this.ConclusionsID is highly prevalent in patients with HFpEF and is associated with worse exercise capacity and functional outcomes, but not hospitalisation or mortality. Our study establishes that ID may play an important a role in HFpEF.

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