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Imbalance of Iron Availability and Demand in Patients With Acute and Chronic Heart Failure

Lukas Lanser1, Gerhard Poelzl2, Moritz Messner2

  • 1Department of Internal Medicine II Medical University of Innsbruck Innsbruck Austria.

Journal of the American Heart Association
|April 19, 2024
PubMed

Insights

Iron deficiency (ID) is common in heart failure patients. Current definitions may overestimate ID, suggesting more specific criteria are needed to identify patients who benefit from iron supplementation.

Area of Science:

  • Cardiology
  • Hematology
  • Biochemistry

Background:

  • Iron deficiency (ID) is a significant comorbidity in acute (AHF) and chronic heart failure (CHF) patients, linked to increased morbidity and mortality.
  • Understanding iron homeostasis is crucial for managing heart failure patients.

Purpose of the Study:

  • To characterize iron homeostasis in heart failure patients using various biomarkers.
  • To evaluate the accuracy of current European Society of Cardiology/American College of Cardiology/American Heart Association (ESC/ACC/AHA) ID definitions in reflecting tissue iron status.

Main Methods:

  • Retrospective cohort study of 277 AHF and 476 CHF patients.
  • Analysis of biomarkers including ferritin, transferrin saturation, soluble transferrin receptor, hepcidin, and reticulocyte hemoglobin.
  • Evaluation of current ESC/ACC/AHA ID definition accuracy.

Main Results:

  • AHF patients exhibited more advanced ID than CHF patients.
  • Current ID definitions identified ID in a significant proportion of patients, but biomarker analysis suggested overestimation, particularly in CHF.
  • More specific ID criteria could reduce unnecessary iron supplementation by up to 65.6% in CHF patients.

Conclusions:

  • The current ESC/ACC/AHA-based ID definition may overestimate true ID in heart failure, especially in CHF.
  • Stricter ID thresholds could better identify heart failure patients with reduced tissue iron availability who would benefit from intravenous iron therapy.
Abstract

Keywords:
acute heart failurechronic heart failurehepcidiniron deficiencyret‐HbsTfR

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