Effect of anaemia and iron deficiency in heart failure with mildly reduced ejection fraction

Tobias Schupp; Kathrin Weidner; Marielen Reinhardt; Noah Abel; Alexander Schmitt; Felix Lau; Maximilian Kittel; Thomas Bertsch; Christel Weiß; Michael Behnes; Ibrahim Akin

doi:10.1111/eci.14205

Effect of anaemia and iron deficiency in heart failure with mildly reduced ejection fraction

Eur J Clin Invest. 2024 Apr 10:e14205. doi: 10.1111/eci.14205. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
² Institute for Clinical Chemistry, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
³ Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany.
⁴ Department of Statistical Analysis, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.

PMID: 38597298
DOI: 10.1111/eci.14205

Abstract

Objective: The present study aims to clarify the prevalence and prognostic impact of anaemia and iron deficiency in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background: The prognostic impact of anaemia and iron deficiency in HFmrEF has not yet been clarified.

Methods: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Patients with anaemia (i.e. haemoglobin <13 g/dL in males and < 12 g/dL in females) were compared to patients without, respectively patients with or without iron deficiency. The primary endpoint was all-cause mortality at 30 months (median follow-up), secondary endpoints comprised HF-related rehospitalisation.

Results: Two thousand one hundred and fifty four patients with HFmrEF with a median haemoglobin level of 12.2 g/dL were included. Anaemia was present in 52% of patients with HFmrEF and associated with a higher risk of all-cause mortality (44% vs. 18%; HR = 3.021; 95% CI 2.552-3.576; p =.001) and HF-related rehospitalisation (18% vs. 8%; HR = 2.351; 95% CI 1.819-3.040; p =.001) at 30 months, which was confirmed after multivariable adjustment. Although iron status was infrequently assessed in anaemics with HFmrEF (27%), the presence of iron deficiency was associated with higher risk of rehospitalisation for worsening HF (25% vs. 15%; HR = 1.746; 95% CI 1.024-2.976; p =.038), but not all-cause mortality (p =.279) at 30 months.

Conclusion: Anaemia and iron deficiency are very common in atleast half of patients with HFmrEF and independently associated with adverse long-term prognosis.

Keywords: HFmrEF; anaemia; heart failure with mildly reduced ejection fraction; iron deficiency.