Iron deficiency in heart failure, an underdiagnosed and undertreated condition during hospitalization
Heart failure (HF) is a chronic medical condition affecting an estimated 1–2% of the world’s population, and as many as 10% of patients age 65 and above. Among patients with HF, iron deficiency (ID) has an estimated prevalence of 30–83%, often without concomitant anemia. Thus, ID in HF is often underdiagnosed unless actively sought after. ID in HF has been shown to be an independent contributor of increased mortality, hospitalization, and early readmission compared with HF patients without ID or HF patients with anemia without ID. Previous trials suggest that intravenous iron supplementation for patients with chronic HF and ID with or without anemia has resulted in improved functional outcomes and quality of life; however, the role of iron supplementation in patients hospitalized with HF has not been well characterized. In this retrospective analysis conducted in a large urban health system, we show that of the greater than 10,000 patients admitted for HF in 1 year, only 158 patients underwent screening for ID. Of these, 109 met criteria for ID. Despite intravenous iron being the standard of care for treatment of ID in HF patients, only 23 patients received this therapy. These data suggest that iron deficiency, despite having major implications in HF, is not being adequately evaluated during hospitalizations for HF. Further, if ID is identified, it is not being appropriately addressed, as per current treatment guidelines.
KeywordsIron deficiency Heart failure Anemia Intravenous iron
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Pennsylvania (confirmation number: cgdeedbi) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
- 3.Benjamin E, Blaha M, Chiuve S, Das S, Deo R, de Ferranti S, Floyd J, Fornage M, Gillespie C, Isasi C, Jimenez M, Jordan LC, Judd S, Lackland D, Lichtman J, Lisabeth L, Liu S, Longenecker C, Mackey R, Matsushita K, Mozaffarian D, Mussolino M, Nasir K, Nasir K, Neumar R, Palaniappan L, Pandey D, Thiagarajan R, Reeves M, Ritchey M, Rodriguez C, Roth G, Rosamond W, Sasson C, Towfighi A, Tsao C, Turner M, Virani S, Voeks J, Willey J, Wilkins J, Wu J, Alger H, Wong S, Muntner P (2017) Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation 135:e146–e603. https://doi.org/10.1161/CIR.0000000000000485 CrossRefGoogle Scholar
- 4.Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC (2001) ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. J Am Coll Cardiol 38:2101–2113. https://doi.org/10.1016/S0735-1097(01)01683-7 CrossRefGoogle Scholar
- 5.Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, Ikonomidis JS, Khavjou O, Konstam MA, Maddox TM, Nichol G, Pham M, Piña IL, Trogdon JG (2013) Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 6:606–619. https://doi.org/10.1161/HHF.0b013e318291329a CrossRefGoogle Scholar
- 7.Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, Lok DJ, Rosentryt P, Torrens A, Polonski L, van Veldhuisen DJ, van der Meer P, Jankowska EA (2013) Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J 165:575–582.e3. https://doi.org/10.1016/j.ahj.2013.01.017 CrossRefGoogle Scholar
- 8.Cohen-Solal A, Damy T, Terbah M, Kerebel S, Baguet J-P, Hanon O, Zannad F, Laperche T, Leclercq C, Concas V, Duvillié L, Darné B, Anker S, Mebazaa A (2014) High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail 16:984–991. https://doi.org/10.1002/ejhf.139 CrossRefGoogle Scholar
- 9.Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, Banasiak W, Polonski L, Filippatos G, McMurray JJV, Anker SD, Ponikowski P (2010) Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 31:1872–1880. https://doi.org/10.1093/eurheartj/ehq158 CrossRefGoogle Scholar
- 10.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Failure Society of America. Circulation 136. https://doi.org/10.1161/CIR.0000000000000509
- 14.Melenovsky V, Petrak J, Mracek T, Benes J, Borlaug BA, Nuskova H, Pluhacek T, Spatenka J, Kovalcikova J, Drahota Z, Kautzner J, Pirk J, Houstek J (2017) Myocardial iron content and mitochondrial function in human heart failure: a direct tissue analysis: iron and mitochondria in heart failure. Eur J Heart Fail 19:522–530. https://doi.org/10.1002/ejhf.640 CrossRefGoogle Scholar
- 15.Miñana G, Cardells I, Palau P, Llàcer P, Fácila L, Almenar L, López-Lereu MP, Monmeneu JV, Amiguet M, González J, Serrano A, Montagud V, López-Vilella R, Valero E, García-Blas S, Bodí V, de la Espriella-Juan R, Sanchis J, Chorro FJ, Bayés-Genís A, Núñez J, for the Myocardial-IRON Investigators (2018) Changes in myocardial iron content following administration of intravenous iron (Myocardial-IRON): study design. Clin Cardiol 41:729–735. https://doi.org/10.1002/clc.22956 CrossRefGoogle Scholar
- 17.Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Lüscher TF, Bart B, Banasiak W, Niegowska J, Kirwan B-A, Mori C, von Eisenhart Rothe B, Pocock SJ, Poole-Wilson PA, Ponikowski P (2009) Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 361:2436–2448. https://doi.org/10.1056/NEJMoa0908355 CrossRefGoogle Scholar
- 18.Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD, for the CONFIRM-HF Investigators (2015) Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 36:657–668. https://doi.org/10.1093/eurheartj/ehu385 CrossRefGoogle Scholar