Key result
In patients admitted with acute heart failure, the prevalence of iron deficiency decreased significantly from 71.8% at admission to 50.3% at 10 weeks post-discharge without iron supplementation.
Why the study?
The prevalence and natural course of iron deficiency in acute heart failure remain unclear.
Observational (n=742)
Yes
Functional iron deficiency often resolves spontaneously during the stabilization of acute heart failure, suggesting that absolute iron deficiency may be a more stable and appropriate therapeutic target for iron supplementation.
Spontaneous resolution of functional ID post-acute HF without supplementation warrants caution before early repletion; leaves open whether absolute ID is the preferred trial target.
AIMS: The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. METHODS AND RESULTS: In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100-299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median [interquartile range] 124 μg/L [56-247] to 150 μg/L [73-277]), transferrin saturation (15% [10-20] to 18% [12-27]), and iron levels (9 μmol/L [6-13] to 11 μmol/L [8-16]) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% [15-29]) and iron levels (to 13 μmol/L [9-17]) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation. CONCLUSIONS: Iron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.
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Dalen et al. (2021) conducted an observational in Acute heart failure (n=742). In patients admitted with acute heart failure, the prevalence of iron deficiency decreased significantly from 71.8% at admission to 50.3% at 10 weeks post-discharge without iron supplementation.
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