Iron deficiency in new onset heart failure: association with clinical factors and quality of life

Abstract Aims The prevalence of iron deficiency (ID) in newly diagnosed heart failure (HF) and the progression of ID in patients after initiation of HF therapy are unknown. We aimed to describe the natural trajectory of ID in patients with new onset HF during the first year after HF diagnosis, assessing associations between ID, clinical factors, and quality of life (QoL). Methods and results A prospective cohort of patients with new onset HF in hospitals or outpatient clinics at five major hospitals in Stockholm, Sweden, during 2015–2018 were analysed with clinical assessment, electrocardiogram, blood samples including iron levels, Minnesota living with heart failure questionnaire (MLHFQ), and echocardiogram at baseline and after 12 months. Of 547 patients with new‐onset HF, 482 (88%) had complete iron data at baseline. Median age was 70 years (interquartile range 61–77) and 311 (65%) were men; 55% of patients had ejection fraction (EF) ≤ 40%, 19% had EF 41–49%, and 26% had HF with preserved EF (HFpEF) Correction added on 26 June 2024, after first online publication: The ‘Mean age was 70 years’ has been corrected to ‘Median age was 70 years’ in this version.. At baseline, 163 patients (34%) had ID defined as ferritin <100 μg/L or ferritin 100–299 μg/L and transferrin saturation <20%. After 12 months of follow‐up, 119 (32%) had ID of the 368 patients who had complete iron data both at baseline and after 12 months and did not receive intravenous (i.v.) iron during follow‐up. During the first year after HF diagnosis, 19% had persistent ID, 13% developed ID, 11% resolved ID, and 57% never had ID, consequently 24% changed their classification. Anaemia at baseline was the strongest independent predictor of ID 1 year after diagnosis odds ratio (OR) 3.91, 95% confidence interval (CI) 1.88–8.13, P < 0.001, followed by HF hospitalization (OR 2.21, 95% CI 1.24–3.95, P < 0.01), female sex (OR 2.04, 95% CI 1.25–3.32, P < 0.01), HFpEF (OR 1.96, 95% CI 1.13–3.39, P < 0.05), and diabetes mellitus (OR 1.92, 95% CI 1.06–3.48, P < 0.05). ID was associated with low QoL at baseline (MLHFQ score mean difference 7.4 points, 95% CI 3.1–11.7, P < 0.001), but not at follow‐up. Conclusions About one third of patients with new onset HF had ID both at the time of HF diagnosis and after 1 year, though a quarter of the patients changed their ID status. Patients with anaemia, HF hospitalization, female gender, HFpEF, or diabetes mellitus at baseline were more likely to have ID after 1 year implying that these should be carefully screened for ID to find those in need of i.v. iron treatment.