High prevalence of iron deficiency in heart failure with preserved ejection fraction

Background: Anaemia and iron deficiency (ID) are common co-morbidities in patients with heart failure with reduced ejection fraction (HF-REF). Treatment with iron replacement improves symptoms and quality of life. The prevalence and relevance of ID is uncertain among patients with heart failure with preserved ejection fraction (HF-PEF). Our aim was to determine the prevalence of ID and anaemia in patients with HF-PEF compared to HF-REF. Methods: Using a prospective observational study of patients with HF baseline blood samples were evaluated for anaemia and ID. Anaemia was defined as Hb<13g/dl in men and <12g/dl in women. ID was defined if ferritin<100mcg/L (absolute ID[AbsID]) or ferritin 100-300mcg/L with a Tsat<20% (relative ID[RelID]). Results: Of 774 patients, 492 (64%) had HF-REF and 282 (36%) had HF-PEF. 440 (57%) had ID; 265 (34%) AbsID and 175 (23%) RelID. Prevalence of ID was higher in HF-PEF than HF- REF (64% vs 53%, p<0.003). Prevalence of AbsID was also higher in HF-PEF than HF- REF (41% vs 30%, p=0.004). Prevalence of RelID was similar (23% vs 22%, p=0.83). Overall, 257 (33%) patients had anaemia. Prevalence of anaemia was higher in HF-PEF than HF-REF (46% vs 29%, p<0.001). In the anaemic subgroup, 78% with HF-PEF had ID (53% AbsID, 26% RelID) vs 68% with HF-REF (40%AbsID, 28%RelID) (p=0.069). In the non-anaemic subgroup, 54% with HF-PEF had ID (33%AbsID, 21%RelID) vs 48% with HF-REF (26%AbsID, 21%RelID) (p=0.24) Conclusion: ID and anaemia are highly prevalent among patients with HF-PEF: two-thirds have ID and half anaemia. Importantly, ID, in particular AbsID, was common even in the absence of anaemia. Treatment of ID improves morbidity in patients with HF-REF. Whether this also applies for patients with HF-PEF needs evaluation.