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Iron deficiency in 78 805 people admitted with heart failure across England: a retrospective cohort study
James M Beattie1, Rani Khatib2,3, Ceri J Phillips4
1Cicely Saunders Institute, King's College London, London, UK.
Insights
Iron deficiency (ID) and iron deficiency anaemia (IDA) affect over a third of heart failure (HF) patients, leading to worse outcomes and increased healthcare costs. Early identification and management of ID/IDA in HF patients are crucial.
Area of Science:
- Cardiology
- Internal Medicine
- Hematology
Background:
- Iron deficiency (ID), with or without anaemia (IDA), is a recognized comorbidity in chronic heart failure (HF).
- The exact prevalence and clinical significance of ID/IDA in patients admitted with HF remain uncertain.
- Understanding these associations is vital for improving patient care and health economics.
Purpose of the Study:
- To determine the prevalence of ID or IDA in adults hospitalized with a primary diagnosis of HF.
- To examine key clinical and economic metrics associated with ID/IDA in this patient population.
- To assess the impact of ID/IDA on patient outcomes and healthcare expenditure.
Main Methods:
- Retrospective cohort study utilizing Hospital Episode Statistics from NHS hospitals in England.
- Inclusion criteria: adults (age ≥21 years) admitted with primary HF diagnosis.
- Data analysis focused on secondary coding for ID/IDA and associated patient metrics.
Main Results:
- 33.7% of 78,805 HF admissions had secondary coding for ID/IDA.
- Patients with ID/IDA were more likely to be admitted as emergencies, older, and female.
- ID/IDA was associated with longer hospital stays, higher per capita costs (£21.5 million excess expenditure), increased HF-related and all-cause readmissions within 30 days, and a statistically significant increase in inpatient mortality.
Conclusions:
- ID/IDA are significant comorbidities in adults hospitalized with acute HF in England.
- These conditions are linked to adverse outcomes for individuals and substantial economic burden on the health system.
- Findings underscore the importance of recognizing and managing ID/IDA in HF patients.
Objectives:
Iron deficiency (ID), with or without anaemia (IDA), is an important comorbidity in people with chronic heart failure (HF), but the prevalence and significance in those admitted with HF is uncertain. We assessed the prevalence of ID or IDA in adults (age ≥21 years) hospitalised with a primary diagnosis of HF, and examined key metrics associated with these secondary diagnoses.
Methods:
A retrospective cohort study of Hospital Episode Statistics describing all adults admitted to National Health Service (NHS) hospitals across England from April 2015 through March 2016 with primary diagnostic discharge coding as HF, with or without subsidiary coding for ID/IDA.
Results:
78 805 adults were admitted to 177 NHS hospitals with primary coding as HF: 26 530 (33.7%) with secondary coding for ID/IDA, and 52 275 (66.3%) without. Proportionately more patients coded ID/IDA were admitted as emergencies (94.8% vs 87.6%; p<0.0001). Tending to be older and female, they required a longer length of stay (15.8 vs 12.2 days; p<0.0001), with higher per capita costs (£3623 vs £2918; p<0.0001), the cumulative excess expenditure being £21.5 million. HF-related (8.2% vs 5.2%; p<0.0001) and all-cause readmission rates (25.8% vs 17.7%; p<0.05) at ≤30 days were greater in those with ID/IDA against those without, and they manifested a small but statistically significant increased inpatient mortality (13.5% v 12.9%; p=0.009).
Conclusions:
For adults admitted to hospitals in England, principally with acute HF, ID/IDA are significant comorbidities and associated with adverse outcomes, both for affected individuals, and the health economy.
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