Iron Deficiency is an Ominous Predictor of Mortality in Elderly Patients with Stable Heart Failure: a Community Based Study

Abstract

Background: Iron deficiency (ID) has been shown to be linked with poor outcomes within heart failure (HF) populations in previous clinical trials. The impact of ID has not been evaluated in stable chronic heart failure (HF) patients in the community. Our objective was to study the role of ID in stable HF patients and its impact on short term survival. Methods: In this study we analysed 512 patients with stable HF under the care of a regional nurse-led community heart failure team. The study started in June 2007 and ended in June 2010. Results: There were 92% of patients on loop diuretics; 83% on ACE Inhibitors, 92% on b-blockers and 48% on aldosterone antagonists. Mean age of the patients was 77.9 years, 43% were females and mean NYHA class was 2.2. Absolute Iron deficiency (ID) and anemia were defined as ferritin <100µg/L and hemoglobin (Hb)<12g/dl, respectively. Mean Hb levels were 14.1; 13.9; 14.0 and 13.7g/dL at 0, 6, 12 and 24 months. Mean serum ferritin levels in the entire study population were 212µg/L at the start, and 197µg/L at the end. The prevalence of ID and anemia was 21.3% and 9.4%at the start, and was 21.5% and 8.4% at the end of the study. The prevalence of ID was 63%vs. 19% in subjects with vs. without anemia [p<0.001]. Risk-adjusted hazard ratios for 24-month mortality were 1.42 (95% confidence interval: 1.09-1.98) for ID and 1.05 (95% confidence interval; 0.87-1.51) for anemic patients respectively.  Conclusions: In our study, ID was prevalent in stable HF patients in the community and was linked with poor clinical outcomes. In addition, ID was a predictor for mortality than additionally to anemia.