Abstract
SummaryAnaemia and iron deficiency (ID) are common and of prognostic importance in heart failure (HF). In both conditions the epidemiology, diagnosis and therapies have been extensively studied in high-income countries but are still largely unexplored in sub-Saharan Africa (SSA).The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF. From a clinical perspective, less attention is paid by clinicians to screening for anaemia in HF, and as far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate interventional approach. Therefore studies are needed to provide more insight into the burden and peculiarities of and intervention for anaemia and ID in HF in SSA, where the pathophysiology might be different from that in high-income countries.There is increasing appreciation that targeting ID may serve as a useful additional treatment strategy for patients with chronic HF in high-income countries. However, there is limited information on the diagnosis of and therapy for ID in HF in SSA, where infections and malnutrition are more likely to influence the situation. This article reviews the present epidemiological gap in knowledge about anaemia and ID in HF, as well as the diagnostic and therapeutic challenges in SSA.
Highlights
The lack of adequate and robust epidemiological data in sub-Saharan Africa (SSA) makes it difficult to recognise the significance of anaemia and iron deficiency (ID) in heart failure (HF)
The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF
Less attention is paid by clinicians to screening for anaemia in HF, and as far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate interventional approach
Summary
As far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate approach to manage anaemia in HF. As the ferritin is elevated in HF due to the inflammatory state, in their 2012 guidelines, the European Society of Cardiology introduced the definition of ID in HF as either serum ferritin < 100 mg/l for absolute ID or 100–299 mg/l and transferrin saturation < 20% for functional ID.[31] The criteria have been used in several clinical trials.[32,33,34] These diagnostic criteria for ID in HF used in high-income countries may not be feasible in SSA due to the lack of diagnostic facilities and the presence of co-existing malnutrition, haemoglobinopathies and infections. Serum ferritin/transferrin saturation (TSAT) has commonly been used in several observational and clinical trials (Table 2) to
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