Frequency of Iron Deficiency among Patients with Heart Failure without Anemia: A Hospital-Based Cross-Sectional Study

Objective: Heart failure is a major global health concern associated with substantial morbidity, mortality, impaired functional capacity, and reduced quality of life. Iron deficiency is an increasingly recognized comorbidity in patients with heart failure and may occur independently of anemia. Altered iron metabolism can adversely affect cellular energy production, myocardial function, and skeletal muscle performance, potentially contributing to symptom burden and functional impairment. Despite its clinical importance, evidence regarding the frequency of iron deficiency among non-anemic patients with heart failure remains limited in local healthcare settings. To determine the frequency of iron deficiency among patients with heart failure without anemia attending a tertiary healthcare institution in Lahore, Pakistan. Methodology: This hospital-based cross-sectional study was conducted in the Department of Cardiology, Bahria Town Hospital, Lahore, Pakistan, from September 2025 to March 2026, following institutional ethical approval (IRBEC/BIH/65-2025). A total of 140 patients aged 30–80 years with diagnosed heart failure and without anemia were enrolled through non-probability consecutive sampling. Demographic characteristics, clinical risk factors, hemoglobin concentrations, serum ferritin levels, and transferrin saturation (TSAT) were recorded. Iron deficiency was operationally defined as serum ferritin below 100 µg/L or ferritin between 100 and 299 µg/L with TSAT below 20%. Results: The mean age of participants was 51.47 ± 11.66 years, and 84 (60.0%) were male. The mean body mass index was 29.94 ± 4.98 kg/m², while the mean hemoglobin concentration was 13.89 ± 1.14 g/dL. Diabetes mellitus was present in 46 (32.9%) participants. The mean serum ferritin concentration was 108.89 ± 42.76 µg/L, and TSAT below 20% was observed in 71 (50.7%) patients. No statistically significant associations were observed between reported iron deficiency status and age group (p=0.804), sex (p=0.890), or diabetes mellitus (p=0.119). Conclusion: The study reported iron deficiency in approximately half of the non-anemic patients with heart failure, suggesting that abnormal iron status may coexist with hemoglobin concentrations above the thresholds used to define anemia. These findings highlight the importance of considering biochemical iron status separately from hemoglobin concentration in patients with heart failure. However, the single-center cross-sectional design limits generalizability and does not establish causality or clinical outcomes.