Abstract 17348: Clinical Associations and Treatment Strategy of Iron Deficiency in the Daily Care of Heart Failure
Introduction: Iron deficiency (ID) is a prevalent co-morbidity in heart failure (HF) and iron supplementation has been reported to reduce HF symptoms and rehospitalisations. We evaluated the clinical associations and prognostic consequences of ID, and the use of iron supplementation.
Methods: In a tertiary referral academic hospital, we routinely measured parameters of iron status in 583 consecutive outpatient heart failure patients. ID was defined as a ferritin<100 μg/l or ferritin 100-300ug/l and transferrin saturation (TSAT)<20%. Patients were categorized based upon the presence or absence of ID. The prognostic impact was assessed using cox-regression analyses (both on the combined endpoint (HF rehospitalisation and all-cause mortality; and on all-cause mortality alone), and further we investigated correlates of ID and ID therapy using logistic regression analyses.
Results: Patients were predominantly male (62%) with a mean (±SD) age of 68±13 years, and 34% of the patients were in NYHA class III/IV. ID was present in 61% of the patients and was positively associated with galectin-3, systolic blood pressure and thrombocytes. ID was independently associated with an increased risk of the combined endpoint (hazard ratio [HR] [95% CI]: 1.56 [1.06 - 2.29], P-value=0.025) and with all-cause mortality (HR [95%CI]: 1.84 [1.13 - 3.02], P-value=0.015). Treatment rate of ID with iron was low; 11% of patients with ID and 7% of non-ID patients received iron supplementation. Although ID in HF is increasingly acknowledged as an important co-morbidity, treatment rate did not increase over recent years. Interestingly, not iron parameters but hemoglobin, a parameter of anemia, was the strongest predictor of iron supplementation (odds ratio [95%CI]: 0.44 [0.32 - 0.60], P-value<0.001).
Conclusions: In the outpatient HF clinic, ID was highly prevalent and associated with unfavorable outcome. Despite known benefits of iron supplementation, treatment rate with iron was low. While most clinical trials were performed in patients with ID regardless of hemoglobin, therapy still is usually based on low hemoglobin levels.
Author Disclosures: N. Grote Beverborg: None. W.C. Meijers: None. P. van der Meer: Research Grant; Significant; Vifor Pharma. Consultant/Advisory Board; Modest; Vifor Pharma. R.A. de Boer: None.
- © 2016 by American Heart Association, Inc.