IRON DEFICIENCY IN HEART FAILURE

Abstract

Background: Data on the burden of Iron deficiency (ID) in Heart failure (HF) patients in India are sparse and there is very little information available about the prevalence of iron deficiency in heart failure with mid-range (HFmrEF) and preserved ejection fraction (HFpEF) in comparison to heart failure with reduced ejection-fraction (HFrEF).
 Aims and Objective: This study was carried out with aim to evaluate iron profile in HF patients and to know the prevalence of ID in HFpEF, HFmrEF and HFrEF in our region.
 Materials and Methods: Patients with clinically diagnosed HF were enrolled in the study. This was a single tertiary care centre, prospective, observational study carried out from December 2017 to November 2018. Patients were classified into HFrEF, HFmrEF and HFpEF on echocardiography. Serum ferritin (micrograms per liter), serum iron (micrograms per liter), total iron binding capacity (micrograms per liter), transferrin (milligrams per deciliter), and transferrin saturation were measured to assess iron status. Absolute ID was defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100–300 mg/L) with low TSAT (<20%).
 Results: A total of 120 patients of HF (66.7% males and 33.3% females) were studied. Out of 120 patients, 78 (65%) patients of HF had ID. Absolute ID was in 38.3% and functional ID was seen in 26.7% patients. 62.5% of males had ID, whereas, 70% of females had ID in HF. Patients with ID had higher NYHA Class, 35.9% compared to 23.8% patients without ID. ID was high in all subsets of HF. ID was found in 61.11% in HFrEF, 67.44% in HFmrEF and 69.57% in HFpEF. P-0.71. 14.1% patients had ID, but no anemia (p- 0.02). In anemic patients, ID was more (85.2%) than non anemic patients (69%).
 Conclusion: In our study, prevalence of ID was higher in patients of HF than that reported from western literature. HFpEF had higher prevalence of ID followed by HFmrEF and HFrEF, respectively. Literature is scanty about HFmrEF, our study has given an insight of ID in this subset of HF. ID can occur even without anemia and females are more prone to have ID in HF. Our study highlights the importance of diagnosis and treatment of ID in all subsets of HF, in order to improve quality of life, morbidity and mortality in patients of HF.
 Keywords: Iron deficiency, Heart Failure, Anemia, HFrEF, HFmrEF, HFpEF