Abstract 8920: Iron Deficiency is an Ominous Predictor of Mortality in Stable Heart Failure Patients in the Community

Abstract

Background: Iron deficiency (ID) has been shown to be linked with multi-faceted clinical consequences in patients with heart failure (HF) enrolled in clinical trials. The predictive value of ID has not been evaluated in ambulatory left ventricular systolic dysfunction (LVSD) patients in the community. METHODS AND RESULTS: We evaluated 512 patients (10.4%) with stable LVSD under the care of a regional nurse-led community heart failure team between June 2007 - November 2009. 92% of patients were on loop diuretics; 83% on ACE Inhibitors, 92% on β-blockers and 48% on aldosterone antagonists. Mean age of the patients was 77.9 ± 4.1 years, 43% were females and mean NYHA class was 2.2 ± 0.7. Absolute Iron deficiency was defined as ferritin <100 µg/L and functional anemia as hemoglobin (Hb) between 9-12g/dl. Mean Hb levels were 14.1± 0.7; 13.9 ± 0.3; 14.0 ± 0.6 and 13.7± 0.2 g/dL at 0, 6, 12 and 24 months. Mean serum ferritin levels in the entire study population were 212 ± 14.9 µg/L at the start and 197 ± 13.8 µg/L at the end. The prevalence of ID and anemia was 21.3 ± 2 % (+95% CI) and 9.4 ± 1.3% respectively at the start of the study. These figures were 21.5±2.1% (ID) and 8.4± 1.7 % (anemia) at the end of the study. 2-year survival was 88% in the entire population; 83% in the anemic group (p=NS) and 76% in ID patients (p<0.001). Risk-adjusted hazard ratios for 24 month mortality were 1.42 (1.09-1.98) and 1.05 (0.87-1.51) for ID and anemic patients respectively. CONCLUSIONS: ID is common in ambulatory HF patients in the community and is associated with worse clinical outcomes. It is also a stronger independent predictor for mortality than anemia in stable LVSD patients.