Why the study?
It was unclear whether absolute or inflammation-driven functional iron deficiency, with and without anaemia, have similar or different consequences for patients with chronic heart failure.
Do anaemia and iron deficiency predict adverse outcomes in patients with chronic heart failure?
Do anaemia and iron deficiency predict adverse outcomes in patients with chronic heart failure?
Anaemia and low tissue iron availability (TSAT <20%) are strong negative predictors of outcome in patients with chronic heart failure, with risk modified by gender, inflammation, and other clinical factors.
Anaemia and TSAT <20% flag higher CHF risk; leaves open whether gender-specific iron repletion improves outcomes.
Aims Anaemia and iron deficiency (ID) are frequently found in patients with chronic heart failure (CHF) and associated with adverse outcome. However, it is unclear whether absolute [transferrin saturation (TSAT) <20%, ferritin <100 μg/L] or inflammation-driven functional ID (TSAT <20%, ferritin >100 μg/L) with and without anaemia had similar or different consequences for such patients. Methods and results Within this retrospective cohort study, 2223 patients (1601 men and 622 women) with CHF, referred to our department, between 2000 and 2018, were followed for a median time of 84 months. Anaemia was found in 393 patients and was an independent predictor for an adverse outcome [HR 2.164 (95% CI 1.865–2.512), P < 0.001]. In 674 patients with available parameters of iron metabolism, ID was present in 228 patients and was associated with an unfavourable outcome [HR 1.499 (95% CI 1.158–1.940), P = 0.002]. ID was best predicting an adverse outcome in men ≤59 years, with heart failure with reduced ejection fraction, preserved kidney function, no inflammation, and a body mass index (BMI) ≥25.5 kg/m2. Functional ID in women and absolute ID in men were associated with poor prognosis. Of note, TSAT <20% but not low ferritin levels were predictive for an adverse outcome. Anaemic patients with high ferritin levels, advanced inflammation, older age, low BMI, male gender, and reduced glomerular filtration rate had the worst prognosis. Conclusions Anaemia and low tissue iron availability as reflected by TSAT <20% are negative predictors of outcome in patients with CHF. Systemic inflammation, renal function, BMI, age, and gender are important contributors for the clinical course.
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Kurz et al. (2020) studied this question.
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