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Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study
Muizz Wahid1,2, Sunjidatul Islam1, Nariman Sepehrvand1,2
1Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.).
Insights
Iron deficiency is common in heart failure (HF) patients, yet treatment often falls short of guidelines. This study highlights the need for better iron management strategies in acute and chronic HF populations.
Area of Science:
- Cardiology
- Hematology
- Public Health
Background:
- Iron deficiency (ID) is linked to adverse outcomes in heart failure (HF), regardless of anemia.
- Current treatment practices for ID in HF patients may not align with established guidelines.
Purpose of the Study:
- To investigate the prevalence of ID and iron deficiency anemia (IDA) in acute and chronic HF patients.
- To examine iron supplementation practices in these patient populations.
- To assess patient eligibility for ongoing clinical trials related to iron therapy in HF.
Main Methods:
- Utilized population-level data from Alberta, Canada (2012-2019) for adult HF patients.
- Categorized patients into acute or chronic HF, defining ID and IDA using laboratory criteria.
- Determined eligibility for AFFIRM-AHF, IRONMAN, and HEART-FID trials.
Main Results:
- High prevalence of ID (72.6% acute, 73.9% chronic) and IDA (51.4% acute, 49.0% chronic) among tested HF patients.
- Iron therapy was administered to 41.8% of acute and 40.5% of chronic HF patients with IDA, and 19.9%-21.7% of ID patients without anemia.
- Oral iron was the most common therapy (28.1%); approximately half the cohort qualified for major iron therapy trials.
Conclusions:
- Investigational and therapeutic approaches for ID in HF patients deviate from current guidelines.
- There is a significant gap in care regarding optimal iron management for HF patients.
- Innovative strategies are necessary to improve iron therapy utilization and patient outcomes in HF.
Background:
Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings.
Methods:
All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF. HF subtypes were determined through echocardiography data, and ID (serum ferritin concentration <100 μg/L, or ferritin concentration between 100 and 300 μg/L along with transferrin saturation <20%), and IDA through laboratory data. Broad eligibility for 3 clinical trials (AFFIRM-AHF [Study to Compare Ferric Carboxymaltose With Placebo in Patients With Acute HF and ID], IRONMAN [Intravenous Iron Treatment in Patients With Heart Failure and Iron Deficiency], and HEART-FID [Randomized Placebocontrolled Trial of Ferric Carboxymaltose as Treatment for HF With ID]) was determined.
Results:
Among the 17 463 patients with acute HF, 38.5% had iron studies tested within 30 days post-index-HF episode (and 34.2% of the 11 320 patients with chronic HF). Among tested patients, 72.6% of the acute HF and 73.9% of the chronic HF were iron-deficient, and 51.4% and 49.0% had IDA, respectively. Iron therapy was provided to 41.8% and 40.5% of patients with IDA and acute or chronic HF, respectively. Of ID patients without anemia, 19.9% and 21.7% were prescribed iron therapy. The most common type of iron therapy was oral (28.1% of patients). Approximately half of the cohort was eligible for each of the AFFIRM-AHF, intravenous iron treatment in patients with HF and ID, and HEART-FID trials.
Conclusions:
Current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations. Considering the gap in care, innovative strategies to optimize iron therapy in patients with HF are required.
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