Iron Repletion in Heart Failure Patients

Abstract

See related article, pp 497–504 There is increasing interest in the role of iron deficiency in causing or worsening congestive heart failure (CHF). A potential role for iron deficiency in playing a causal role in CHF is suggested by the fact that iron deficiency is common in CHF with or without anemia. In a recent study of 546 patients with stable systolic heart failure, if iron deficiency was defined as ferritin <100 μg/L, or as ferritin 100 to 300 μg/L and percent transferrin saturation of <20%, it was found in 37% of CHF patients; 32% did not have anemia, and 57% did have anemia (anemia defined as a hemoglobin [Hb] level of <12 g/dL in women and <13 g/dL in men).1 Iron deficiency was more prevalent in women, in those with more advanced CHF as measured by New York Heart Association class, those with higher N-terminal pro β-type natriuretic peptide levels (a sign of more severe CHF), and those with higher C-reactive protein levels (a sign of increased inflammation). After a mean duration of 731 days, in multivariable models, iron deficiency, but not anemia, was related to increased risk of death or heart transplantation, the adjusted hazard ratio being 1.58 ( P <0.01). In a study of anemic CHF patients, approximately half had serum iron levels below normal, and the great majority also had elevated soluble transferrin receptor (a dependable measure of iron deficiency).2 In another study of anemia in severe CHF, markedly reduced iron stores in the bone marrow were found in 73% of the cases.2,3 Thus, absolute iron deficiency (defined as a serum ferritin <100 μg/L and % transferrin saturation <20%) or functional iron deficiency (defined as a serum ferritin ≥100 μg/L and percentage transferrin …