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Prognostic implications of iron deficiency in patients with atrial fibrillation, with and without chronic heart
Abdullahi Ahmed Mohamed1, Daniel Mølager Christensen2,3, Milan Mohammad4
1Department of Cardiology, Herlev Hospital, Herlev, Denmark abmoh06410@gmail.com.
Insights
Iron deficiency (ID) in atrial fibrillation (AF) patients is linked to higher mortality, especially when defined by transferrin saturation (TSAT) or serum iron levels. These criteria are crucial for risk stratification in AF, regardless of heart failure status.
Area of Science:
- Cardiology
- Hematology
- Clinical Research
Background:
- Iron deficiency (ID) is prevalent in atrial fibrillation (AF) patients.
- Prognostic implications and diagnostic criteria for ID in AF, particularly with or without heart failure (HF), require clarification.
Purpose of the Study:
- To assess the associations between different ID definitions and clinical outcomes in AF patients.
- To determine the prognostic value of various ID diagnostic criteria in AF, considering HF status.
Main Methods:
- A nationwide cohort study of 10,834 AF patients in Denmark (2008-2019).
- ID was defined by European Society of Cardiology (ESC) guidelines, ferritin <100 ng/mL, transferrin saturation (TSAT) <20%, and serum iron ≤13 µmol/L.
- Cox regression models were used to evaluate associations with all-cause mortality, cardiovascular mortality, and hospitalisation, adjusted for confounders.
Main Results:
- ID prevalence varied significantly (36.2%–62.7%) across definitions.
- TSAT <20% and serum iron ≤13 µmol/L were associated with increased all-cause and cardiovascular mortality in both HF and non-HF AF patients.
- ESC guidelines or ferritin <100 ng/mL definitions were not linked to mortality but associated with higher hospitalisation rates in HF patients.
Conclusions:
- ID definitions based on TSAT <20% or serum iron ≤13 µmol/L are clinically relevant for predicting mortality in AF patients.
- These specific ID criteria are valuable for risk stratification in AF, irrespective of heart failure presence.
Background:
Iron deficiency (ID) is common in patients with atrial fibrillation/flutter (AF), but its prognostic implications and optimal diagnostic criteria, particularly in those with and without heart failure (HF), remain unclear. This study assessed the associations between different ID definitions and clinical outcomes in patients with AF.
Methods:
This Danish nationwide cohort study included 10 834 patients with AF who underwent iron studies between 2008 and 2019, stratified by HF status. ID was defined using four criteria: European Society of Cardiology (ESC) guidelines, ferritin <100 ng/mL, transferrin saturation (TSAT) <20% and serum iron ≤13 µmol/L. Associations between ID definitions and all-cause mortality, cardiovascular mortality and all-cause hospitalisation were evaluated using Cox regression models, adjusted for confounders.
Results:
Prevalence of ID varied substantially across definitions, ranging from 36.2% to 62.7%. Over a median follow-up of 31 months, TSAT <20% was associated with increased all-cause and cardiovascular mortality in both HF (HR 1.25, 95% CI 1.14 to 1.37 and HR 1.31, 95% CI 1.14 to 1.49, respectively) and patients without HF (HR 1.39, 95% CI 1.18 to 1.64 and HR 1.54, 95% CI 1.18 to 2.00, respectively). Similarly, serum iron ≤13 µmol/L was associated with higher all-cause and cardiovascular mortality in HF (HR 1.44, 95% CI 1.31 to 1.58 and HR 1.42, 95% CI 1.24 to 1.63, respectively) and patients without HF (HR 1.67, 95% CI 1.41 to 1.97 and HR 1.46, 95% CI 1.13 to 1.89, respectively). ID defined by ESC guidelines or ferritin <100 ng/mL was not associated with mortality in either group but was linked to higher all-cause hospitalisation in patients with HF (HR 1.15, 95% CI 1.08 to 1.23 and HR 1.16, 95% CI 1.09 to 1.23, respectively).
Conclusions:
ID defined by TSAT <20% or serum iron ≤13 µmol/L is associated with increased mortality in patients with AF, irrespective of HF status, highlighting these criteria as clinically relevant for risk stratification.
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