Natural history and prognostic significance of iron deficiency and anaemia in ambulatory patients with chronic heart failure

Graham, F. J., Masini, G., Pellicori, P. , Cleland, J. G.F. , Greenlaw, N., Friday, J., Kazmi, S. and Clark, A. L. (2022) Natural history and prognostic significance of iron deficiency and anaemia in ambulatory patients with chronic heart failure. European Journal of Heart Failure, 24(5), pp. 807-817. (doi: 10.1002/ejhf.2251) (PMID:34050582)

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Abstract

Aims: Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. Methods and results: We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65–79) years, 70% men, 51% with heart failure with reduced ejection fraction) 1 year apart. ID was defined as serum iron ≤13 µmol/L and anaemia as haemoglobin <13.0 g/dL for men or <12.0 g/dL for women. FAIR-HF criteria for ID were also considered. At baseline, 10% had anaemia without ID, 23% had ID without anaemia, 20% had both, and 47% had neither. Percentages changed little over 1 year, but 157 (30%) patients had new-onset ID, 104 (16%) new-onset anaemia, whilst ID resolved in 173 (44%) and anaemia in 63 (23%). Compared to those who remained iron replete (iron >13 µmol/L), mortality was higher in those with persistent or incident ID at 1 year [hazard ratio (HR) 1.81 (1.23–2.67), and HR 1.40 (0.91–2.14), respectively] in multivariable models (P = 0.02). Compared to persistent ID, resolution of ID was associated with a lower mortality [HR 0.61 (0.44–0.86); P = 0.004]. Changes in ID defined by FAIR-HF criteria were not similarly associated with mortality. Anaemia was associated with a poor outcome even if it resolved. Conclusions: The prevalence and incidence of ID and anaemia are high in chronic heart failure but so is the rate of resolution. Persistent or incident ID, defined by a serum iron ≤13 µmol/L, is associated with higher mortality and resolution of ID with lower mortality.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Masini, Dr Gabriele and Friday, Jocelyn Marie and Greenlaw, Miss Nicola and Graham, Dr Fraser and Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Graham, F. J., Masini, G., Pellicori, P., Cleland, J. G.F., Greenlaw, N., Friday, J., Kazmi, S., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:28 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Journal of Heart Failure 24(5): 807-817
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science