Hiroki Nakano1, Toshiyuki Nagai2, Varun Sundaram3, Michikazu Nakai4, Kunihiro Nishimura4, Yasuyuki Honda5, Satoshi Honda5, Naotsugu Iwakami5, Yasuo Sugano5, Yasuhide Asaumi5, Takeshi Aiba5, Teruo Noguchi5, Kengo Kusano5, Hiroyuki Yokoyama5, Hisao Ogawa5, Satoshi Yasuda5, Taishiro Chikamori6, Toshihisa Anzai7. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: tnagai@huhp.hokudai.ac.jp. 3. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA; Royal Brompton Hospital, London, United Kingdom; Harefield Hospital, London, United Kingdom. 4. Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan. 5. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 6. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 7. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Abstract
BACKGROUND: Iron deficiency (ID) is commonly observed in chronic heart failure (HF) patients and is associated with worse clinical outcomes. While ID is frequent finding in hospitalized heart failure (HHF), its impact on long-term outcome in HHF patients remains unclear. METHODS: We evaluated iron status at discharge in 578 HHF patients. Absolute ID was defined as serum ferritin <100 μg/L, and functional ID (FID) was defined as serum ferritin of 100-299 μg/L with transferrin saturation <20%. The primary outcome of interest was the composite of all-cause mortality and HF admission at one year. RESULTS: Among the study population, 185 had absolute ID, 88 had FID and 305 had no evidence of ID. At one-year post-discharge, 64 patients had died and 112 had been readmitted with HF. Patients with absolute ID had more adverse events than those with FID or no ID (p = 0.021). In multivariate Cox regression analyses, absolute ID was significantly associated with increased risk of adverse events at one year (HR 1.50, 95% CI 1.02-2.21, p = 0.040) compared with the remaining patients. Sensitivity analysis revealed that its prognostic effect did not differ across anemic status, or between HF with reduced and preserved ejection fraction (p for interaction = 0.17, 0.68, respectively). CONCLUSION: Absolute ID, but not FID, at discharge was associated with increased risk of one-year mortality or HF admission in patients with HHF. Further studies are required to evaluate the role of repleting iron stores and its impact on clinical outcomes in patients with HHF.
BACKGROUND:Iron deficiency (ID) is commonly observed in chronic heart failure (HF) patients and is associated with worse clinical outcomes. While ID is frequent finding in hospitalized heart failure (HHF), its impact on long-term outcome in HHF patients remains unclear. METHODS: We evaluated iron status at discharge in 578 HHF patients. Absolute ID was defined as serum ferritin <100 μg/L, and functional ID (FID) was defined as serum ferritin of 100-299 μg/L with transferrin saturation <20%. The primary outcome of interest was the composite of all-cause mortality and HF admission at one year. RESULTS: Among the study population, 185 had absolute ID, 88 had FID and 305 had no evidence of ID. At one-year post-discharge, 64 patients had died and 112 had been readmitted with HF. Patients with absolute ID had more adverse events than those with FID or no ID (p = 0.021). In multivariate Cox regression analyses, absolute ID was significantly associated with increased risk of adverse events at one year (HR 1.50, 95% CI 1.02-2.21, p = 0.040) compared with the remaining patients. Sensitivity analysis revealed that its prognostic effect did not differ across anemic status, or between HF with reduced and preserved ejection fraction (p for interaction = 0.17, 0.68, respectively). CONCLUSION: Absolute ID, but not FID, at discharge was associated with increased risk of one-year mortality or HF admission in patients with HHF. Further studies are required to evaluate the role of repleting iron stores and its impact on clinical outcomes in patients with HHF.
Authors: Sarah Fitzsimons; Tee Joo Yeo; Lieng H Ling; David Sim; Kui Toh Gerard Leong; Poh Shuan Daniel Yeo; Hean Yee Ong; Fazlur Jaufeerally; Tze P Ng; Katrina Poppe; Mayanna Lund; Gerry Devlin; Richard Troughton; Carolyn S P Lam; A Mark Richards; Robert N Doughty Journal: ESC Heart Fail Date: 2021-09-30
Authors: Kieran F Docherty; Paul Welsh; Subodh Verma; Rudolf A De Boer; Eileen O'Meara; Olof Bengtsson; Lars Køber; Mikhail N Kosiborod; Ann Hammarstedt; Anna Maria Langkilde; Daniel Lindholm; Dustin J Little; Mikaela Sjöstrand; Felipe A Martinez; Piotr Ponikowski; Marc S Sabatine; David A Morrow; Morten Schou; Scott D Solomon; Naveed Sattar; Pardeep S Jhund; John J V McMurray Journal: Circulation Date: 2022-08-16 Impact factor: 39.918
Authors: Philipp Lacour; Phi Long Dang; Daniel Armando Morris; Abdul Shokor Parwani; Wolfram Doehner; Franziska Schuessler; Felix Hohendanner; Frank R Heinzel; Andrea Stroux; Carsten Tschoepe; Wilhelm Haverkamp; Leif-Hendrik Boldt; Burkert Pieske; Florian Blaschke Journal: ESC Heart Fail Date: 2020-03-18