Iron deficiency in chronic heart failure: An international pooled analysis.
Klip, IJsbrand T. MD a; Comin-Colet, Josep MD, PhD b; Voors, Adriaan A. MD, PhD a; Ponikowski, Piotr MD, PhD c; Enjuanes, Cristina MD b; Banasiak, Waldemar MD, PhD c; Lok, Dirk J. MD d; Rosentryt, Piotr MD e; Torrens, Ainhoa MD b; Polonski, Lech MD, PhD e; van Veldhuisen, Dirk J. MD, PhD e; van der Meer, Peter MD, PhD a,*; Jankowska, Ewa A. MD, PhD b
[Article]
American Heart Journal.
165(4):575-582e3, April 2013.
(Format: HTML, PDF)
Background: Iron deficiency (ID) is an emerging problem in patients with chronic heart failure (HF) and can be a potential therapeutic target. However, not much is known about the prevalence, predictors, and prognosis of ID in patients with chronic HF.
Methods: In an international pooled cohort comprising 1,506 patients with chronic HF, we studied the clinical associates of ID and its prognostic consequences.
Results: Iron deficiency (defined as a ferritin level <100 [mu]g/L or ferritin 100-299 [mu]g/L with a transferrin saturation <20%) was present in 753 patients (50%). Anemic patients were more often iron deficient than nonanemic patients (61.2% vs 45.6%, P < .001). Other independent predictors of ID were higher New York Heart Association class, higher N-terminal pro-brain-type natriuretic peptide levels, lower mean corpuscular volume levels, and female sex (all P < .05). During follow-up (median 1.92 years, interquartile range 1.18-3.26 years), 440 patients died (29.2%). Kaplan-Meier survival analysis revealed ID as a strong predictor for mortality (log rank [chi]2 10.2, P = .001). In multivariable hazard models, ID (but not anemia) remained a strong and independent predictor of mortality (hazard ratio 1.42, 95% confidence interval 1.14-1.77, P = .002). Finally, the presence of ID significantly enhanced risk classification and integrated discrimination improvement when added to a prediction model with established risk factors.
Conclusions: Iron deficiency is common in patients with chronic HF, relates to disease severity, and is a strong and independent predictor of outcome. In this study, ID appears to have greater predictive power than anemia.
(C) 2013Elsevier, Inc.