Anemia and Iron Deficiency in Patients With Chronic Heart Failure: Prevalence and Outcomes

Key Points

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  Questions What is the prevalence, using various definitions, of anemia and hematinic deficiencies in patients with heart failure and how are they related to prognosis?

  
  


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  Findings In this observational study of 4456 patients referred to a community-based heart failure clinic, anemia was present in one-third of patients, of whom two-thirds had iron deficiency. Both anemia and markers of iron deficiency, except ferritin, were associated with a poorer prognosis, including an excess of cancer deaths.

  
  


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  Meaning In patients with heart failure, anemia is commonly associated with iron deficiency, and anemia and iron deficiency may both be therapeutic targets.

  
  
  

  Methods

  
  

  Patients referred with suspected HF to a cardiology outpatient clinic serving a mixed urban-rural community (Kingston-upon-Hull and East Riding of Yorkshire, United Kingdom; population, approximately 550 000) from January 1, 2001, through December 31, 2010, were invited to participate in this study. Follow-up data were censored on December 13, 2011. The only exclusion criterion was the inability to provide valid informed consent because of age younger than 18 years or important cognitive dysfunction.

  
  
  
  
  

  Discussion

  
  
  
  

  This analysis confirms that anemia is common in patients referred for investigation of suspected HF, especially if the diagnosis of HF is subsequently confirmed by objective evidence of cardiac dysfunction. The prevalence of anemia is similar regardless of the underlying HF phenotype and, even if borderline, is often associated with iron deficiency.The severity of anemia and iron deficiency were both strongly related to all-cause and cardiovascular mortality on univariate analyses. Patients with anemia were at increased risk of sudden and HF-related death. Elimination of iron or hemoglobin from the multivariable model strengthened the association of the other with outcome. Therefore, it is likely that both the severity of anemia and iron deficiency contribute to an adverse outcome in patients with HF.