Iron Deficiency in Older Adults Hospitalized for Acute Heart Failure: Prevalence, Clinical Correlates and One-Year Outcomes in a Moroccan Prospective Study

Abstract

Background: Iron deficiency is a common comorbidity in patients with heart failure. This association is often underrecognized in clinical practice, despite its important implications for symptoms and prognosis. Iron deficiency has been associated with worse symptoms, impaired functional status, and poorer clinical outcomes. Data from North Africa remain scarce, particularly in older adults hospitalized for acute or decompensated heart failure Methods: A single-center (Ibn Rochd University Hospital in Casablanca) prospective observational study was conducted in the Cardiology Division. The study included consecutive patients aged ≥65 years admitted for acute heart failure, including both de novo presentations and acute decompensation of previously known chronic heart failure during a 12-month period. Iron deficiency was defined as a ferritin concentration <100 ng/mL, or 100-299 ng/mL with transferrin saturation <20%. Clinical, laboratory, and echocardiographic data were collected at admission. Patients were followed for one year for a composite outcome of heart failure rehospitalization or all-cause death. Results: Fifty patients were included; the median age was 84 years (range, 65-104). Men and women were equally represented. Hypertension was present in 82%, diabetes in 32%, and active smoking in 18%. Functional limitation was substantial, with 50% of patients in NYHA class II, 40% in class III, and 10% in class IV. Anemia occurred in 52% of this cohort, and among those with Anemia, 82% of those were iron deficient. Among patients with iron deficiency, 63% were anemic and 37% were not. Echocardiographic findings displayed LVEF <45% for 38%; LV end-diastolic diameter >55 mm 24%; TAPSE <16 mm 24%; elevated pulmonary artery systolic pressure 40%; and a PASP/TAPSE ratio >3 mmHg/mm of 30%. At one year, event-free survival for the composite endpoint of heart failure rehospitalization or all-cause death was 94%. Given the very low number of events observed during follow-up, subgroup comparisons were descriptive and should be interpreted cautiously. Conclusions: In this cohort of Moroccan patients hospitalized for acute heart failure, iron deficiency was highly prevalent and was frequently present in the absence of overt anemia. The data has highlighted the need for routine iron testing during the inpatient stay; as this will allow for the identification of patients who may later qualify for intravenous iron therapies after they have undergone a period of medical stabilization.