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Sung HP, Hsu CY, Lee YH, Lin PL, Liao CT, Chung FP, Ko SL, Huang CY, Lin KC, Chang HY. Iron deficiency in Taiwanese patients with heart failure and reduced ejection fraction. J Chin Med Assoc 2023; 86:725-731. [PMID: 37314316 DOI: 10.1097/jcma.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Iron deficiency (ID) is a common comorbidity among patients with heart failure and reduced ejection fraction (HFrEF), and is associated with poorer outcomes independent of anemia. This study aimed to evaluate the prevalence and prognostic significance of ID in Taiwanese patients with HFrEF. METHODS We included HFrEF patients from two multicenter cohorts at different periods. The multivariate Cox regression analysis was applied to assess the risk of outcomes associated with ID, accounting for the varying risk of death. RESULTS Of the 3612 patients with HFrEF registered from 2013 to 2018, 665 patients (18.4%) had available baseline iron profile measurements. Of these, 290 patients (43.6%) were iron deficient; 20.2% had ID+/anemia+, 23.4% ID+/anemia-, 21.5% ID-/anemia+, and 34.9% ID-/anemia-. Regardless of anemia status, patients with coexisting ID had a higher risk than those without ID (all-cause mortality: 14.3 vs 9.5 per 100 patient-years, adjusted hazard ratio [HR] 1.33; 95% confidence interval [CI], 0.96-1.85; p = 0.091; cardiovascular mortality: 10.5 per 100 patient-years vs 6.1, adjusted HR 1.54 [95% CI, 1.03-2.30; p = 0.037]; cardiovascular mortality or first unplanned hospitalization for HF: 36.7 vs 19.7 per 100 patient-years, adjusted HR 1.57 [95% CI, 1.22-2.01; p < 0.001]). Among patients eligible for treatment in the IRONMAN trial design (43.9%), parenteral iron therapy was estimated to reduce heart failure hospitalizations and cardiovascular deaths by 13.7 per 100 patient-years. CONCLUSION Iron profiles were tested in less than one-fifth of the Taiwanese HFrEF cohort. ID was present in 43.6% of tested patients and was independently associated with poor prognosis in these patients.
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Affiliation(s)
- Hsiao-Ping Sung
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Po-Lin Lin
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - Fa-Po Chung
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Lun Ko
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Yao Huang
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Scicchitano P, Iacoviello M, Massari A, De Palo M, Potenza A, Landriscina R, Abruzzese S, Tangorra M, Guida P, Ciccone MM, Caldarola P, Massari F. Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role. Biomedicines 2023; 11:biomedicines11030972. [PMID: 36979951 PMCID: PMC10046168 DOI: 10.3390/biomedicines11030972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this study was to evaluate the relationship between anaemia and biomarkers of central/peripheral congestion in heart failure (HF) and the impact on mortality. We retrospectively evaluated 434 acute/chronic HF (AHF/CHF) patients. Anaemia was defined as haemoglobin levels <12 g/dL (women) or <13 g/dL (men). The brain natriuretic peptide (BNP) and hydration index (HI) were measured. The endpoint of the study was all-cause mortality. Anaemia occurred in 59% of patients with AHF and in 35% with CHF (p < 0.001) and showed a significant correlation with the NYHA functional class and renal function. BNP and HI were significantly higher in patients with anaemia than in those without anaemia. Independent predictors of anaemia included BNP, estimated creatinine clearance (eCrCL), and HI. The all-cause mortality rate was 21%, which was significantly higher in patients with anaemia than in those without anaemia (30% vs. 14%, p < 0.001; hazard ratio: 2.6). At multivariate Cox regression analysis, BNP, eCrCL, and HI were independent predictors for mortality (Hazard ratios: 1.0002, 0.97, and 1.05, respectively), while anaemia was not. Anaemia correlates with HF status, functional class, renal function, BNP, and HI. Anaemia was not an independent predictor for mortality, acting as a disease severity marker in congestive patients rather than as a predictor of death.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | | | - Micaela De Palo
- Cardiac Surgery Unit, Policlinic University Hospital, 70124 Bari, Italy
| | - Angela Potenza
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | | | - Silvia Abruzzese
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Maria Tangorra
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
| | - Piero Guida
- Ospedale Generale Regionale "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Marco Matteo Ciccone
- Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Francesco Massari
- Cardiology Section, Hospital "F. Perinei" Altamura, 70022 Altamura, Italy
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Jayagopal P, Sastry SL, Nanjappa V, Abdullakutty J, Joseph J, Vaidyanathan P, Kabra N, Manokar P, Ghanta SS, Sharma V, Mishra TK, Jathappa N, Singh V, Routray S, Mandal S, Bhalla N, Dorairaj P, Mehta N, Kumbla D, Rane AR, Matia TK, Jain D, Rege G, Modi S, Chopra V, Mohanan P, Geevar Zachariah A, Ravindranath K, Chakraborty R, Srinivas B, Raghu T, Manjunath C. Clinical characteristics and 30-day outcomes in patients with acute decompensated heart failure: Results from Indian College of Cardiology National Heart Failure Registry (ICCNHFR). Int J Cardiol 2022; 356:73-78. [DOI: 10.1016/j.ijcard.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 11/05/2022]
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Iron-Deficiency Anemia in Women of Reproductive Age in Urban Areas of Quetta District, Pakistan. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6677249. [PMID: 35187169 PMCID: PMC8849966 DOI: 10.1155/2022/6677249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
Anemia is associated with poor health outcomes, and the prevalence of anemia is a significant public health indicator for both developed and developing countries. Iron-deficiency anemia (IDA) is the most common type of anemia, which often develops during pregnancy. A cross-sectional study was conducted in the urban areas of Quetta city among the women of reproductive age (15-49 years) to update the status of IDA in the region. The study participants (n = 216) were selected on a random basis, and the samples were further distributed by age. Overall, 75% of females were nonanemic, and among those that were anemic, 2% were severe, 13% were moderately, and 10% were mildly anemic. Among the IDA-affected women, 83% were non-pregnant. Age-wise distribution of IDA revealed no significant difference among different age groups, but numerically higher observations were recorded in the age groups of less than 30 years. The highest number of moderately IDA-affected women (15%) were in the age group 15-19 with the following IDA indicating parameters: hemoglobin 9.64 g/dl, mean corpuscular volume 63.11 fl, mean corpuscular hemoglobin 20.40%, red cell distribution 19.28%. This study will be beneficial for illustrating the requirement and the development of a program to raise extended awareness in the Quetta communities to overcome the negative health effects of IDA on the female population.
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Alnuwaysir RIS, Hoes MF, van Veldhuisen DJ, van der Meer P, Beverborg NG. Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. J Clin Med 2021; 11:125. [PMID: 35011874 PMCID: PMC8745653 DOI: 10.3390/jcm11010125] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential micronutrient for a myriad of physiological processes in the body beyond erythropoiesis. Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF), with a prevalence reaching up to 59% even in non-anaemic patients. ID impairs exercise capacity, reduces the quality of life, increases hospitalisation rate and mortality risk regardless of anaemia. Intravenously correcting ID has emerged as a promising treatment in HF as it has been shown to alleviate symptoms, improve quality of life and exercise capacity and reduce hospitalisations. However, the pathophysiology of ID in HF remains poorly characterised. Recognition of ID in HF triggered more research with the aim to explain how correcting ID improves HF status as well as the underlying causes of ID in the first place. In the past few years, significant progress has been made in understanding iron homeostasis by characterising the role of the iron-regulating hormone hepcidin, the effects of ID on skeletal and cardiac myocytes, kidneys and the immune system. In this review, we summarise the current knowledge and recent advances in the pathophysiology of ID in heart failure, the deleterious systemic and cellular consequences of ID.
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Affiliation(s)
| | | | | | | | - Niels Grote Beverborg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (R.I.S.A.); (M.F.H.); (D.J.v.V.); (P.v.d.M.)
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Xia H, Shen H, Cha W, Lu Q. The Prognostic Significance of Anemia in Patients With Heart Failure: A Meta-Analysis of Studies From the Last Decade. Front Cardiovasc Med 2021; 8:632318. [PMID: 34055927 PMCID: PMC8155282 DOI: 10.3389/fcvm.2021.632318] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Anemia is a commonly occurring comorbidity in patients with heart failure (HF). Although there are a few reports of a higher prevalence of mortality and hospitalization-related outcomes due to accompanying anemia, other studies suggest that anemia does not have an adverse impact on the prognostic outcomes of HF. Two meta-analyses in the past decade had reported the adverse impact of anemia on both mortality and hospitalization- related outcomes. However, only one of these studies had evaluated the outcome while using multivariable adjusted hazard ratios. Moreover, several studies since then reported the prognostic influence of anemia in HF. In this present study, we evaluate the prognostic impact of anemia on mortality and hospitalization outcomes in patients with HF. Methods: We carried out a systematic search of the academic literature in the scientific databases EMBASE, CENTRAL, Scopus, PubMed, Cochrane, ISI Web of Science, clinicaltrial.gov, and MEDLINE based on the PRISMA guidelines. Meta-analysis was then performed to evaluate the effect (presented as risk ratio) of anemia on the overall mortality and hospitalization outcome in patients with HF. Results: Out of 1,397 studies, 11 eligible studies were included with a total of 53,502 (20,615 Female, 32,887 Male) HF patients (mean age: 71.6 ± 8.3-years, Hemoglobin: 11.9 ± 1.5 g/dL). Among them, 19,794 patients suffered from anemia (Hb: 10.5 ± 1.6), and 33,708 patients did not have anemia (Hb: 13.2 ± 1.7 g/dL). A meta-analysis revealed a high-odds ratio (OR) for the overall mortality in patients with anemia (OR: 1.43, 95% CI: 1.29–1.84). A high-risk ratio was also reported for hospitalization as the outcome in patients with anemia (1.22, 1.0–1.58). Conclusion: This systematic review and meta-analysis provide evidence of the high risk of mortality and hospitalization-related outcomes in patients with HF and anemia. The study confirms the findings of previously published meta-analyses suggesting anemia as an important and independent risk factor delineating the prognostic outcome of chronic HF.
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Affiliation(s)
- Haijiang Xia
- Department of Cardiology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Hongfeng Shen
- Department of Cardiology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Wei Cha
- Department of Cardiology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Qiaoli Lu
- Department of General Medicine, Zhuji People's Hospital of Zhejiang Province, Shaoxing, China
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Raina S, Katna A, Dhiman H, Sharma R, Kumar M, Yadav RS. Prevalence of anemia and iron deficiency among patients with heart failure admitted in a tertiary care hospital of sub-Himalayan region in North India. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2021. [DOI: 10.4103/jcpc.jcpc_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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