Effects of Iron Deficiency Anemia on Functional Status of Patients of Heart Failure with Reduced Ejection Fraction

Objective: To evaluate effects of iron deficiency anaemia on functional status of patients with heart failure with reduced ejection fraction (HfrEF). Study Design: Analytical cross-sectional study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Multan Pakistan, from Dec 2024 to Sep 2025. Methodology: A total of 320 adult patients with chronic HFrEF were enrolled through consecutive sampling. Functional status was assessed by New York Heart Association (NYHA) class, six-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Iron deficiency was defined as serum ferritin <100 µg/L or 100–299 µg/L with transferrin saturation (TSAT) <20%. Haemoglobin, ferritin and TSAT were measured. Comparisons between IDA (Group-A) and non-IDA (Group-B) groups were performed. Multivariable linear regression was applied to identify independent predictors of 6MWT distance. Results: Iron deficiency was observed in 196(61.3%) patients. Compared to non-deficient patients, those with IDA had lower mean haemoglobin (11.17±0.95 vs. 13.54±0.87 g/dL, p<0.001), ferritin (63.95 vs. 170.70 µg/L, p<0.001), TSAT (15.65% vs. 28.35%, p<0.001), 6MWT distance (280.98±44.56 vs. 303.32±42.51 m, p<0.001), and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (42.72±8.91 vs. 47.28±8.76, p<0.001). Regression analysis showed transferrin saturation (β=0.18, p=0.015) and haemoglobin (β=0.23, p=0.011) as independent predictors of six-minute walk test (6MWT) distance. Conclusion: IDA significantly impairs functional capacity and quality of life in patients with HFrEF. Routine screening and correction of iron deficiency should be integrated into heart failure management to improve outcomes.