Key result
Functional iron deficiency in hospitalized heart failure patients was not associated with a statistically significant difference in major adverse cardiovascular events compared to normal iron levels (36.5% vs 24.3%, p=0.354).
Why the study?
Iron deficiency is common in heart failure, but most studies have focused on low ferritin levels, leaving the relevance and impact of functional iron deficiency in hospitalized patients unclear.
Does functional iron deficiency worsen short-term clinical outcomes in hospitalized patients with heart failure compared to normal iron levels?
Observational (n=96)
No
Does functional iron deficiency worsen short-term clinical outcomes in hospitalized patients with heart failure compared to normal iron levels?
Answers are grounded in this paper and cite their sources.
No MACE difference by iron status in this HF cohort; leaves open prognostic role of functional iron deficiency.
Background Iron deficiency (ID) is common in heart failure (HF) and is present in up to 80% of hospitalized patients. The majority of the studies have focused on describing patients with low ferritin levels. We studied functional iron deficiency (FID) in heart failure in a single-center observational study, with a focus on its relevance in the current era and its impact on outcomes in hospitalised patients. Methods Patients with HF and normal hemoglobin were considered and divided into 2 groups: absolute ID (serum ferritin < 100 mg/L) and FID (normal serum ferritin, i.e., 100-300 mg/L with low transferrin saturation (TSAT; <20%). Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females. Patients were classified into four HF classes based on ejection fraction (EF). EF of ≥50% was taken as HFpEF (heart failure with preserved ejection fraction), 41-49% EF as HFmrEF (heart failure with mildly reduced ejection fraction), and EF <40% as HFrEF (heart failure with reduced ejection fraction). A one-year follow-up was done to assess the New York Heart Association (NYHA) functional class, hemoglobin levels, and recurrent hospitalizations (if any). Results In total, 53 patients, of whom 43 (81%) were males and 10 (19%) were females, were studied. Follow-up data of 29 patients showed outcomes such as deaths (n=6; 11%), recurrent hospitalization for HF (8 patients; 24%), and prolonged hospital stay (n=1). Twenty-four patients (45%) showed clinical improvement on follow-up, among whom 15 patients (62.5%) received IV iron supplementation. Conclusion Functional ID, as determined by low TSAT, represents a significant proportion of HF who are iron-deficient. These patients have outcomes similar to those of patients with normal iron levels. IV iron supplementation resulted in symptomatic improvement; however, this was not statistically significant. In view of this, we hypothesize that the term "functional iron deficiency" may not be deemed relevant in the context of HF, especially in the presence of multiple other factors influencing iron levels. Further large-scale studies are needed to establish this.
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Tulluru et al. (2025) conducted an observational in Heart Failure (n=96). Functional iron deficiency vs. Normal iron levels was evaluated on Major adverse cardiovascular events (MACE) (p=0.354). Functional iron deficiency in hospitalized heart failure patients was not associated with a statistically significant difference in major adverse cardiovascular events compared to normal iron levels (36.5% vs 24.3%, p=0.354).
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