01 Jul Iron Deficiency Common In Heart Failure Patients and Linked To Worse Outcomes
MedicalResearch.com Interview with:
John G. F. Cleland, MD, FRCP, FESC
Department of Cardiology
Hull York Medical School, University of Hull, Castle Hill Hospital, Kingston-Upon-Hull
National Heart and Lung Institute
Royal Brompton and Harefield Hospitals Imperial College
London, United Kingdom
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This analysis shows that iron deficiency is very common in patients with heart failure and often leads to anaemia and that the prevalence of both iron deficiency and anaemia are highly sensitivity to the criteria used to define them. The World Health Organization defines anaemia as a haemoglobin concentration of <13g/dL in men and <12g/dL in women but doctors should realise this is the lower limit of normal and haemoglobin concentrations should ideally be about 2g/dL higher than this. A man with a haemoglobin of 12g/dL is quite severely anaemic. This study suggest that iron deficiency is common when haemoglobin drops below 14g/dL for men and 13g/dL for women.
MedicalResearch.com: What should readers take away from your report?
Response: Serum iron and transferrin saturation were highly correlated (raising the question of the need to measure both) and both were strongly related to anaemia. In contrast, serum ferritin, the most widely [supposed] measure of iron deficiency, was more strongly related to measures of inflammation than anaemia.
Lower concentrations of haemoglobin and serum iron and lower transferrin saturation were associated with a higher mortality. In contrast, lower serum ferritin was associated with a better prognosis until levels got very low (<20ng/mL). Ferritin is highly correlated with markers of inflammation (like high-sensitivity CRP) in patients with heart failure and acts like a marker of inflammation which is associated with a poor prognosis.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Therefore, serum ferritin is a poor measure of iron deficiency in patients with heart failure. Many patients with normal serum ferritin (defined by many as >100ng/ml) have iron deficiency. Clinical trials of intravenous iron for patients with heart failure should be aware of this issue to ensure they enroll appropriate patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: There is a large outcome study of intravenous iron in patients with heart failure on-going in the UK (IRONMAN).
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Cleland JF, Zhang J, Pellicori P, et al. Prevalence and Outcomes of Anemia and Hematinic Deficiencies in Patients with Chronic Heart Failure. JAMA Cardiol.Published online June 29, 2016. doi:10.1001/jamacardio.2016.1161.
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