What is the clinical evidence from this study?

Study design: Observational. Population: Acute heart failure (n=742). Primary outcome: Percentage of patients with iron deficiency at admission.

What does this research mean for the field?

In patients admitted with acute heart failure, the prevalence of iron deficiency decreases significantly from 71.8% at admission to 50.3% at 10 weeks post-discharge without iron supplementation, largely due to the spontaneous resolution of functional iron deficiency. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 4, 2021Open Access

Acute Heart Failure and Iron Deficiency: A Prospective, Multicentre, Observational Study

Key Result

In patients admitted with acute heart failure, the prevalence of iron deficiency decreased significantly from 71.8% at admission to 50.3% at 10 weeks post-discharge without iron supplementation.

Study Design

Type

Observational (n=742)

Multicenter

Yes

Structured PICO

Population

742 adult patients admitted with an episode of acute heart failure (AHF), irrespective of LVEF and left or right-sided HF. Median age 78, 42.5% female. Excluded: history of erythropoietin stimulating agent therapy, intravenous iron therapy, and/or blood transfusion within 3 months prior to hospitalization; oral iron therapy in the past 4 weeks; systemic chemotherapy and/or radiotherapy in the 3 months prior.

Outcome

Percentage of patients with iron deficiency (ferritin <100 μg/L = absolute ID or ferritin 100-299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2)surrogate

Functional iron deficiency often resolves spontaneously during the stabilization of acute heart failure, suggesting that absolute iron deficiency may be a more stable and appropriate therapeutic target for iron supplementation.

Limitations

High amount of missing data due to reliance on clinical daily routine blood samples
Some patients received iron therapy although this was discouraged by the protocol
Only used iron parameters available in daily clinical practice (ferritin, serum iron, and TSAT) without more extensive data like hepcidin

Abstract

AIMS: The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. METHODS AND RESULTS: In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100-299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median interquartile range 124 μg/L 56-247 to 150 μg/L 73-277), transferrin saturation (15% 10-20 to 18% 12-27), and iron levels (9 μmol/L 6-13 to 11 μmol/L 8-16) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% 15-29) and iron levels (to 13 μmol/L 9-17) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation. CONCLUSIONS: Iron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.

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