What question did this study set out to answer?

To analyze the prevalence and clinical outcomes of hospitalized acute heart failure patients with iron deficiency defined by transferrin saturation.

February 6, 2026

Prevalence and outcomes of iron deficiency based on transferrin saturation in patients with acute heart failure

Key Points

To analyze the prevalence and clinical outcomes of hospitalized acute heart failure patients with iron deficiency defined by transferrin saturation.
Retrospective analysis of an acute heart failure registry from 2015 to 2023.
Iron deficiency defined as transferrin saturation < 20%.
Patients categorized into four groups based on iron deficiency and anaemia status.
Primary outcome measured was composite all-cause mortality and rehospitalisation within one year.
61% of analyzed patients had iron deficiency and 65% had anaemia.
Event rates for patients with iron deficiency were significantly higher compared to those without.
Hazard ratios indicated increased risk of adverse outcomes for those with iron deficiency, regardless of anaemia status.

Abstract

Abstract Background Iron deficiency (ID) has been increasingly recognised as a major comorbidity in patients with heart failure. The current definition of ID in heart failure is based on serum ferritin and transferrin saturation (TSAT). However, recent studies suggest that defining ID using TSAT alone may provide greater prognostic value than the conventional ferritin-based definition and better predict responses to iron supplementation. In light of these findings, proposals have emerged to redefine ID solely based on TSAT. Nonetheless, real-world evidence regarding TSAT-based ID definition remains limited and insufficiently explored. Purpose This study aimed to investigate the prevalence and clinical outcomes of hospitalised patients with heart failure and ID defined by TSAT. Methods We retrospectively analysed data from a single-centre acute heart failure registry at our institution between January 2015 and December 2023. ID was defined as TSAT 20%, while anaemia was defined as a serum haemoglobin level 13.0 g/dL in males and 12.0 g/dL in females. Exclusion criteria included in-hospital death, loss to follow-up, mechanical circulatory support, dialysis, or treatment with oral or intravenous iron supplementation. Patients were classified into four groups: no ID without anaemia (ID−/A−), ID without anaemia (ID+/A−), no ID with anaemia (ID−/A+), and ID with anaemia (ID+/A+). Clinical characteristics and outcomes were compared among these groups. The primary outcome was a composite of all-cause mortality and rehospitalisation for worsening heart failure within one year after discharge. Results A total of 1,535 consecutive patients were screened, of whom 322 met the exclusion criteria. Among the 1,212 eligible patients, TSAT was assessed in 828 (68%) during hospitalisation, and they were included in the final analysis. Their mean age was 75 ± 12 years, 57% were male, and 29% had an ischaemic aetiology. The prevalence of ID and anaemia was 61% (505/828) and 65% (536/828), respectively. The composite event rates were 11% in the ID−/A− group (n=148), 21% in the ID+/A− group (n=144), 30% in the ID−/A+ group (n=175), and 29% in the ID+/A+ group (n=361). Kaplan–Meier analysis demonstrated significantly higher composite event rates in patients with ID, regardless of anaemia status (Figure). In the Cox regression analysis, compared with the ID−/A− group as the reference, the ID+/A− group (hazard ratio HR=2.22, p=0.010), the ID−/A+ group (HR=3.27, p0.001), and the ID+/A+ group (HR=3.04, p0.001) were all significantly associated with an increased risk of events, even after adjusting for confounding factors (Table). Conclusions In hospitalised patients with acute heart failure, ID defined by TSAT 20% was highly prevalent and significantly associated with worse outcomes, irrespective of anaemia status.Figure Table

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