Key result
Iron deficiency linked to ~97% higher odds of NYHA class III-IV symptoms in heart failure.
Why the study?
Most evidence on iron deficiency in heart failure originates from hospital-based cohorts, leaving its epidemiology and clinical implications in primary care populations poorly described.
Does iron deficiency worsen symptom severity in primary care patients with heart failure?
Cross-Sectional (n=466)
Yes
Does iron deficiency worsen symptom severity in primary care patients with heart failure?
Odds Ratio: 1.97 (95% CI 1.18–3.31)
Absolute Event Rate: 35.5% vs 18.7%
p-value: p=0.010
Iron deficiency is common among primary care patients with heart failure and is independently associated with a higher symptom burden, highlighting the clinical relevance of assessing iron status in this setting.
Extends iron deficiency epidemiology to primary care HF; leaves open whether screening improves outcomes.
Background Iron deficiency is a common and clinically relevant comorbidity in heart failure, associated with reduced functional capacity, higher symptom burden, and increased hospitalisation risk. Most evidence on iron deficiency in heart failure originates from hospital-based cohorts, whereas the epidemiology and clinical implications in primary care populations remain poorly described. This study aimed to determine the prevalence of iron deficiency among primary care patients with heart failure in southern Sweden and to examine its association with symptom severity. Methods This cross-sectional analysis used baseline data from the Heart Failure in Southern Sweden study, a prospective intervention project conducted at 20 primary health care centres. Adult patients with heart failure across all left ventricular ejection fraction categories were included. Iron deficiency was defined as transferrin saturation < 20%. Results In total, 466 primary care patients with heart failure were included, of whom 124 (26.7%) had iron deficiency. Symptom severity was higher in patients with iron deficiency: 35.5% were classified as New York Heart Association (NYHA) class III–IV, compared with 18.7% among patients without iron deficiency. Similar findings were observed in the subgroup with left ventricular ejection fraction below 50%, where 25.2% had iron deficiency and 42.6% were classified as NYHA III–IV compared with 18.4% among patients without iron deficiency. In multivariable analysis adjusting for clinically relevant covariates, iron deficiency remained associated with NYHA class III–IV (OR 1.97, 95% CI 1.18–3.31, p = 0.010). Conclusions Iron deficiency is common among patients with heart failure managed in primary care and remained associated with higher symptom burden after adjustment for prespecified covariates. These findings highlight the potential clinical relevance of assessment of iron status in primary care. Trial registration ClinicalTrials.gov, NCT04129658. Registered on 15 October 2019.
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Vinge et al. (2026) conducted a cross-sectional in Heart failure (n=466). Iron deficiency vs. No iron deficiency was evaluated on NYHA class III-IV (OR 1.97, 95% CI 1.18-3.31, p=0.010). Iron deficiency was associated with a significantly higher symptom burden (NYHA class III-IV) compared to no iron deficiency in primary care patients with heart failure (OR 1.97).
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