Acute heart failure and iron deficiency: a prospective, multicentre, observational study

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Iron deficiency (ID) prevalence and natural course in acute heart failure (AHF) are not well-defined.
• Understanding ID in AHF is crucial for patient management and outcomes.

Purpose of the Study:

• To investigate the prevalence of ID in AHF patients upon admission, at discharge, and up to 3 months post-discharge.
• To analyze the natural course of absolute and functional ID in AHF.

Main Methods:

• Prospective, multicenter observational study enrolling 742 AHF patients.
• Assessment of ID using ferritin and transferrin saturation levels at three time points: admission (T0), prior to discharge (T1), and 10 weeks post-discharge (T2).
• Defined absolute ID as ferritin <100 μg/L and functional ID as ferritin 100-299 μg/L with transferrin saturation <20%.

Main Results:

• Iron deficiency was highly prevalent, present in 71.8% of patients at admission (44.1% absolute, 27.7% functional).
• ID prevalence decreased to 56.4% at discharge and 50.3% at 3 months, with significant improvements in ferritin, transferrin saturation, and iron levels observed.
• Absolute ID persisted in 66% of patients from admission to 3 months, while functional ID resolved in 56% during AHF treatment without iron supplementation.

Conclusions:

• Iron deficiency is a common comorbidity in AHF patients.
• Functional ID often resolves during AHF treatment, suggesting it may reflect altered iron availability rather than true deficiency.
• Absolute ID is more persistent, highlighting the need for further investigation into its long-term management in AHF.