Iron deficiency (prevalence 57-75%) was associated with lower quality of life across all LVEF categories and increased mortality and HF hospitalizations in patients with LVEF <50% (p<0.05).
Cohort (n=3,642)
Does the presence of iron deficiency impact quality of life and prognostic outcomes across the spectrum of left ventricular ejection fraction in patients with heart failure?
Iron deficiency is highly prevalent across the heart failure spectrum and is consistently associated with worse quality of life and adverse clinical outcomes in patients with LVEF <50%, though its prognostic impact in HFpEF is less clear and definition-dependent.
p-value: p=<0.05
Abstract Aims Iron deficiency (ID) is prevalent in heart failure (HF). While the impact of ID is well-documented in those with left ventricular ejection fraction (LVEF) 50 (HFrEF 50 (HFpEF) is uncertain. We aimed to elucidate and compare the clinical relevance of ID across the LVEF spectrum using multiple definitions. Methods Patients with known LVEF and iron parameters from the index and validation cohort of The BIOSTAT-CHF study were pooled (n=3642). ID was defined using three criteria: 1) IDTSAT: transferrin saturation (TSAT) 20%, 2) IDSI: serum iron ≤13 μmol/L, and 3) IDESC: the ESC guideline definition (ferritin 100 µg/L or 100–299 µg/L with TSAT 20%). Results The prevalence of ID ranged from 57–75% depending on definition and LVEF, with the highest rates in HFpEF and in very low LVEF. More than half of patients met all three definitions, but nearly one-third were classified discordantly. ID was consistently associated with lower quality of life and greater physical limitations (both P. 01) across all definitions and LVEF categories. Independent associates of ID included female sex, higher heart rate, proton pump inhibitor use, anemia, hypoalbuminemia, worse renal function, and fluid retention. ID was associated with increased CV and non CV death, all-cause mortality, HF hospitalizations, and their composite in patients with LVEF 50% across all definitions (p0. 05). In HFpEF, no definition showed consistent prognostic significance, though interactions with LVEF group were observed for IDTSAT and IDESC (pᵢnteraction 0. 05). Conclusion ID is common and clinically relevant across the HF spectrum, irrespective of definition, and is associated with impaired quality of life and adverse outcomes in patients with LVEF 50%. In HFpEF, however, the prognostic impact of ID appears less pronounced and may depend on the definition applied, highlighting the need for refined diagnostic criteria in this group.
Alnuwaysir et al. (2026) conducted a cohort in Heart failure (n=3,642). Iron deficiency vs. No iron deficiency was evaluated on Quality of life, physical limitations, mortality, and HF hospitalizations (p=<0.05). Iron deficiency (prevalence 57-75%) was associated with lower quality of life across all LVEF categories and increased mortality and HF hospitalizations in patients with LVEF <50% (p<0.05).
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