Prevalence and prognostic significance of iron deficiency anemia among heart failure patients: A prospective observational study

Abstract

ABSTRACT Background: Patients with chronic heart failure (CHF) frequently have associated iron deficiency, which may or may not be associated with anemia. Studies to ascertain the impact of repleting iron in patients with CHF and various other prognostic markers are lacking in Indian patients and the Indian context. Objectives: The objective is to study the prevalence of iron deficiency anemia in patients with CHF and its prognostic significance in predicting major adverse cardiovascular events (MACEs) during 6 months of follow-up along with the role of other clinical and demographic variables. Methodology: A prospective, observational, hospital-based study conducted in a government tertiary medical center in south India on patients admitted with the diagnosis of CHF. Full demographic and clinical characterization and all relevant laboratory investigations including iron profile were done per protocol. The incidence of a MACE (rehospitalization for heart failure or death) and its association with iron deficiency was studied at the end of a 6-month follow-up. Results: A total of 388 patients were followed for 6 months. Out of those, 211 patients (54%) developed composite outcomes. Old age, coronary artery disease, atrial fibrillation, previous heart failure history, chronic kidney disease, and reduced left ventricular ejection fraction were independent predictors of composite outcome. The prevalence of anemia in the study population was 71%, and iron deficiency was 63% (20% absolute and 43% relative). Iron deficiency without anemia was also an independent predictor of the composite outcome. Conclusions: This study highlights the underestimated and neglected burden of iron deficiency in CHF patients in India. It also suggests further large-scale studies to characterize this easily treatable condition better and consider routine testing of iron profiles in future Indian guidelines.