Abstract 14991: Diagnosis and Treatment of Iron Deficiency and Anemia in Chronic Heart Failure: Current Practice in Four European Countries
Introduction: Patients (pts) with chronic heart failure (CHF) frequently present with iron deficiency (ID) and anemia, two risk factors for mortality. Intravenous (iv) iron can significantly improve NYHA class and quality of life in iron deficient CHF pts with or without anemia (FAIR-HF). We hypothesized that awareness about ID is underestimated and evaluated current practice in the management of anemia and ID in CHF pts.
Method: Randomly recruited cardiologists in 4 European countries (Austria, Italy, The Netherlands, Sweden) spending >50% of working time on patient-care and seeing >10 CHF pts per month completed surveys on their last five CHF pts treated for ID within six months prior to the survey. The survey was performed from Aug-Sep 2010. Validation of these online questionnaires was done by sample testing.
Results are presented as median between and [range] across countries. Results: 121 physicians (106 hospital-, 15 office-based) returned data on 595 pts (60% [43-62%] male; 53% [37-63%] >70 years old). Tests performed at initial diagnosis of anemia included hemoglobin (Hb) in 68% [65-74%] of pts, ferritin in 39% [21-60%] and transferrin saturation (TSAT) in 10.8% [6.4-20.6%]. Median Hb and ferritin at diagnosis were comparable between countries (95 g/L [92-105 g/L] and 28 µg/L [17-44 µg/L], respectively), whereas TSAT varied more (18% [10-30%]). Moderate to severe anemia (Hb <100 g/L) was seen in 64% [41-71%], absolute ID (ferritin <100 µg/L) in 83% [70-95%] and functional ID (TSAT <20%) in 57% [30-100%].
Most pts received iron treatment (90% [86-98%]); however, only a small proportion of iron-treated pts received iv iron (13% [9-23%]). An erythropoiesis-stimulating agent was given to 20% [18-36%] and although only 6% (0-19%) had an Hb <80 g/L at diagnosis, 23% [12-29%] received a blood transfusion at some stage in their treatment.
Conclusions: There is considerable variation in the management of ID and anemia in CHF pts across these European countries. Assessment of iron status is mainly based on the acute phase protein ferritin. TSAT, a marker of FID is underused. Despite the impact of chronic diseases on iron homeostasis, still most pts receive an oral iron. Thus, awareness about the possible clinical benefit of iv iron in CHF pts needs to be broadened.
- © 2011 by American Heart Association, Inc.