Anemia and Iron Deficiency in Patients With Chronic Heart Failure: Prevalence and Outcomes
This study investigates the epidemiology of anemia and iron deficiency in a broad range of patients referred to a cardiology clinic with suspected heart failure.
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?
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.
Meaning In patients with heart failure, anemia is commonly associated with iron deficiency, and anemia and iron deficiency may both be therapeutic targets.
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.
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.
In patients with heart failure, with or without a reduced left ventricular ejection fraction, anemia and iron deficiency are common and many patients have both, suggesting that iron deficiency could be an important cause of anemia in this setting. Serum concentrations of iron and transferrin saturation are more strongly associated with anemia than are serum concentrations of ferritin, which may be greatly influenced by activation of inflammatory pathways. Both anemia and iron deficiency are associated with a higher all-cause mortality, mostly driven by cardiovascular deaths. The incidence of gastrointestinal malignant tumors is fairly low in patients with heart failure and only slightly higher in patients with anemia or iron deficiency. These data should help with the planning, execution, and interpretation of future interventional trials designed to treat iron deficiency and/or anemia.
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