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Anemia, iron deficiency common in patients with chronic HF
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Both anemia and iron deficiency are common in patients with chronic HF and associated with all-cause and CV mortality, researchers reported in JAMA Cardiology.
John G. F. Cleland, MD, FRCP, FESC, department of cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital in the United Kingdom and colleagues examined the epidemiology of anemia and iron deficiency in 4,456 patients with suspected HF who were referred to a single cardiology outpatient clinic between 2001 and 2010. Median follow-up was 7.7 years.
John G. F. Cleland
Patients (median age, 73 years; 40% women) completed a standardized symptom questionnaire and underwent clinical examination, imaging and blood tests. Of the 4,456 patients, 1,791 (40.2%) had left ventricular systolic dysfunction.
Anemia was discovered in 1,237 patients (27.8%), with 643 patients having a mild form of anemia and 240 patients having a more severe form. In addition, iron levels were less than 45 µg/dL in 497 (14%) patients and less than 67 µg/dL in 1,296 (36.6%) patients. According to Cleland and colleagues, patients with anemia were more likely to have lower concentrations of iron. Serum iron had a strong association with transferrin saturation (r = 0.906; P < .001), mean corpuscular hemoglobin (r = 0.462; P < .001) and mean corpuscular volume (r = 0.273; P = .001). The association with ferritin, however, was weaker (r = 0.207; P = .01).
Iron deficiency was observed in, depending on definition, 43.2% to 68% of patients with anemia and 14.7% to 35.3% of those without anemia, Cleland and colleagues wrote.
Overall, lower levels of hemoglobin (HR =0.92; 95% CI, 0.89-0.95; P < .001) and serum iron (HR = 0.98; 95% CI, 0.97-0.99; P = .007) were associated with higher all-cause mortality and CV mortality.
“The lack of a robust blood test for iron deficiency creates uncertainty about its role in the development of anemia. An observational study such as this can help identify how sensitive the prevalence of anemia and iron deficiency are to changes in definition and their association with outcome,” Cleland and colleagues wrote. “However, demonstrating an association between a variable and an outcome does not prove causality.” – by Tracey Romero
Disclosure: The study was partially funded by grants from Amgen and Vifor Pharma. Cleland reports receiving research support from Amgen and Vifor Pharma. The other researchers report no relevant financial disclosures.
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