Criteria for iron deficiency in patients with heart failure

Masini, G., Graham, F. J., Pellicori, P. , Cleland, J. G.F. , Cuthbert, J. J., Kazmi, S., Inciardi, R. M. and Clark, A. L. (2022) Criteria for iron deficiency in patients with heart failure. Journal of the American College of Cardiology, 79(4), pp. 341-351. (doi: 10.1016/j.jacc.2021.11.039) (PMID:35086656)

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Abstract

Background: Guidelines on heart failure (HF) define iron deficiency (ID) as a serum ferritin <100 ng/mL or, when 100-299 ng/mL, a transferrin saturation (TSAT) <20%. Inflammation (common in HF) may hinder interpretation of serum ferritin. Objectives: This study sought to investigate how different definitions of ID affect its prevalence and relationship to prognosis in ambulatory patients with chronic HF. Methods: Prevalence, relationship with patients’ characteristics, and outcomes of various ID definitions were evaluated among patients with HF referred to a regional clinic (Hull LifeLab) from 2001 to 2019. Results: Of 4,422 patients with HF (median age 75 years [range: 68-82 years], 60% men, 32% with reduced left ventricular ejection fraction), 46% had TSAT <20%, 48% had serum iron ≤13 μmol/L, 57% had serum ferritin <100 ng/mL, and 68% fulfilled current guideline criteria for ID, of whom 35% had a TSAT >20%. Irrespective of definition, ID was more common in women and those with more severe symptoms, anemia, or preserved ejection fraction. TSAT <20% and serum iron ≤13 μmol/L, but not guideline criteria, were associated with higher 5-year mortality (HR: 1.27; 95% CI: 1.14-1.43; P < 0.001; and HR: 1.37; 95% CI: 1.22-1.54; P < 0.001, respectively). Serum ferritin <100 ng/mL tended to be associated with lower mortality (HR: 0.91; 95% CI: 0.81-1.01; P = 0.09). Conclusions: Different definitions of ID provide discordant results for prevalence and prognosis. Definitions lacking specificity may attenuate the benefits of intravenous iron observed in trials while definitions lacking sensitivity may exclude patients who should receive intravenous iron. Prespecified subgroup analyses of ongoing randomized trials should address this issue.

Item Type:Articles
Additional Information:Drs Pellicori and Cleland are supported by the British Heart Foundation Centre of Research Excellence (RE/18/6/34217).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Masini, Dr Gabriele and Graham, Dr Fraser and Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Masini, G., Graham, F. J., Pellicori, P., Cleland, J. G.F., Cuthbert, J. J., Kazmi, S., Inciardi, R. M., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
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:Journal of the American College of Cardiology
Publisher:Elsevier
ISSN:0735-1097
ISSN (Online):1558-3597
Published Online:24 January 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American College of Cardiology 79(4):341-351
Publisher Policy:Reproduced under a Creative Commons License

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