Article

Impact of Iron Deficiency in Heart Failure

Disclosure: Josep Comin-Colet has received consulting fees from Vifor Pharma and was a member of the FAIR-HF and CONFIRM-HF steering committees.

Received:

Accepted:

Citation:Cardiac Failure Review 2015;1(1 Suppl 1):3.

Support: Vifor Pharma funded a writer to attend the symposium and develop this manuscript accordingly.

Open access:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

HF has a significant impact on QoL that is worse than the impact of other chronic diseases, particularly in terms of physical function.1 HF is characterised by exercise intolerance, fatigue and dyspnoea, and is classified according to severity in New York Heart Association (NYHA) classes I–IV, where Class I is no limitation of physical activity and Class IV is the inability to undertake any physical activity without discomfort.2 An emerging problem in HF is ID. ID is prevalent among patients with HF; in a recent international pooled cohort study (n=1,506), ID (defined as serum ferritin <100 µg/L or <299 µg/L if transferrin saturation [TSAT] <20 %) was found in 50 % of the total patient population. ID is the commonest cause of anaemia, but even in the absence of anaemia, ID was present in 45.6 % of patients (see Figure 1).3 Disease severity, assessed by NYHA class and N-terminal of pro-brain natriuretic peptide (NT-proBNP) levels, proved to be powerful and independent predictors of a disordered iron status. Furthermore, ID has been found to be an independent factor associated with reduced exercise capacity,4 reduced QoL5,6 and poor outcome.3

In 2012, the ESC Guidelines for the diagnosis and treatment of acute and chronic HF recognised ID as a co-morbidity in HF for the first time and recommended diagnosis of ID based on iron parameters in all patients suspected of having HF.2,7 Furthermore, the guidelines now detail the mechanism of action of iron in muscle function (and therefore the explanation for deficiency-related pathology and onset of symptoms in HF independent of the pro-erythropoietic function of iron); the need for routine monitoring for ID; and the beneficial effects on symptoms, physical performance and QoL of treating ID with intravenous (i.v) ferric carboxymaltose (FCM). Based on the findings of the Ferric Carboxymaltose Assessment in Patients With IRon Deficiency and Chronic Heart Failure (FAIR-HF) study, which found that treatment with i.v. FCM in iron deficient patients with chronic HF improves symptoms, exercise capacity and QoL irrespective of whether anaemia was present or not. FCM is now considered as a possible treatment option in the current ESC Guidelines for HF.2,7,8 In conclusion, ID is a significant burden in HF and merits further investigation.

 

Prevalence of Iron Deficiency in Chronic Heart Failure

Article image

References

  1. Lesman-Leegte I, Jaarsma T, Coyne JC, et al., Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls, J Card Fail, 2009;15:17–23.
    Crossref | Pubmed
  2. McMurray JJ, Adamopoulos S, Anker SD, et al., ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC, Eur Heart J, 2012;33:1787–847.
    Crossref | Pubmed
  3. Klip IT, Comin-Colet J, Voors AA, et al., Iron deficiency in chronic heart failure: an international pooled analysis,
    Am Heart J, 2013;165:575–82 e3.
    Crossref | Pubmed
  4. Jankowska EA, Rozentryt P, Witkowska A, et al., Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure, J Card Fail, 2011;17:899–906.
    Crossref | Pubmed
  5. Comin-Colet J, Enjuanes C, González G, et al., Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status, Eur J Heart Fail, 2013;15:1164–72.
    Crossref | Pubmed
  6. Enjuanes C, Klip IT, Bruguera J, et al., Iron deficiency and health-related quality of life in chronic heart failure: results from a multicenter European study, Int J Cardiol, 2014;174:268–75.
    Crossref | Pubmed
  7. McMurray JJ, Adamopoulos S, Anker SD, et al., ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC, Eur J Heart Fail, 2012;14:803–69.
    Crossref | Pubmed
  8. Yeo TJ, Yeo PS, Ching-Chiew Wong R, et al., Iron deficiency in a multi-ethnic Asian population with and without heart failure: prevalence, clinical correlates, functional significance and prognosis, Eur J Heart Fail, 2014;16:1125–32.
    Crossref | Pubmed