PREVALENCE AND CLINICAL SIGNIFICANCE OF IRON DEICIENCY IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE: RESULTS OF A SINGLE-CENTER COHORT STUDY

Highlights

• Iron deficiency is one of the most common comorbidities in heart failure, associated with a negative prognosis; however, the significance of iron deficiency in patients with acute decompensated heart failure remains uncertain.
• The obtained results allowed us to expand the profile of patients with acute decompensated heart failure and evaluate the contribution of iron deficiency to the course of the disease and the long-term prognosis of patients.

Aim. To determine the prevalence of iron deficiency (ID), to assess its clinical and prognostic significance, and its impact on one-year outcomes in patients with acute decompensated heart failure, based on data from a single-center cohort study.

Methods. This prospective cohort study consecutively (from January 1, 2023 to January 1, 2024) included 812 patients admitted with acute decompensated heart failure. The observation period was from January 1, 2023 to January 1, 2025, inclusive. The median age was 72 [57; 83] years.

Results. The clinical phenotypes of patients with ADHF were predominantly represented by an ischemic origin of heart failure. All patients with ADHF had a high prevalence of hypertension and a high Charlson comorbidity index. It was found that patients with ID had significantly higher NT-proBNP values ​​than patients without ID: 2810.8 [1 783.6; 4 198.3] versus 1 981.2 [1 221.5; 3 241.7] pg/ml. Patients with ID had a higher prevalence of major underlying diseases: type 2 diabetes (n = 181, 37.0% vs n = 102, 31.5%; p < 0.05), obesity (n = 378, 77.3% vs n = 170, 52.6%, p < 0.05), CKD (n = 263, 53.9% vs n = 144, 44.5%, p < 0.05); as well as older age (76 [54; 83] vs 69 [47; 79] years). The total number of adverse events was higher in the group of patients with ID.

Conclusions. The prevalence of iron deficiency in patients with ADHF was 60%. Patients with ID were characterized by older age, a high prevalence of type 2 diabetes, obesity, and CKD, as well as a greater number of adverse events during the long-term follow-up period.

1. Chronic heart failure. Clinical guidelines 2020. Rossiyskiy kardiologicheskiy zhurnal – Russian Journal of Cardiology. 2020;25(11):4083 (In Russ.). doi: 10.15829/1560-4071-2020-4083.

2. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemjeva E.G., Badin Yu.V., Bakulina E.V., Vinogradova N.G., Galyavich A.S., Ionova T.S., Kamalov G.M., Kechedzhieva S.G., Koziolova N.A., Malenkova V.Yu., Malchikova S.V., Mareev Yu.V., Smirnova E.A., Tarlovskaya E.I., Shcherbinina E.V., Yakushin S.S. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Cardiology. 2021;61(4):4–14. doi: 10.18087/cardio.2021.4.n1628.

3. Rakisheva AG, Kuanyshbekova RT. 2023 Updated European Society of Cardiology guidelines on heart failure. Russian Journal of Cardiology. 2024;29(2S):5841. (In Russ.). doi:10.15829/1560-4071-2024-5841.

4. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MSh, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay ChM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2020;141(9):e139–e596. doi: 10.1161/CIR.0000000000000757

5. Arutyunov AG, Dragunov DO, Arutyunov GP, Rylova AK, Pashkevich DD. The first open study of acute decompensated heart failure syndrome and comorbidities in the Russian Federation. Independent ORACUL-RF registry. Cardiology. 2015;55(5):12–21 (In Russ.). doi: 10.18565/cardio.2015.5.12-21.

6. Signer CE, Biciusca V, Abdul-Razzak J, Popescu IAS, Geormăneanu C, Singer MM, Mărginean CM, Popescu M. Associated factors in pediatric patients admitted with severe iron-deficiency anemia in the last seven years – the experience of a single pediatric unit. Rom J Morphol Embryol. 2023;64(3):419–426. doi: 10.47162/RJME.64.3.1

7. Smirnova M.P., Chizhov P.A. Factors associated with iron deficiency in heart failure. Cardiovascular Therapy and Prevention. 2023;22(2):3367. (In Russ.). doi: 10.15829/1728-8800-2023-3367.

8. Tajes M, Diez-Lopez C, Enjuanes C, Moliner P, Ferreiro JL, Garay A, Jiménez-Marrero S, Yun S, Sosa SG, Alcoberro L, González-Costello J, García-Romero E, Yañez-Bisbe L, Benito B, Comín-Colet J. Neurohormonal activation induces intracellular iron deficiency and mitochondrial dysfunction in cardiac cells. Cell Biosci. 2021;11:89. doi: 10.1186/s13578-021-00605-5.

9. Moliner P, Enjuanes C, Tajes M, Cainzos-Achirica M, Lupón J, Garay A, Jimenez-Marrero S, Yun S, Farré N, Cladellas M, Díez C, Gonzalez-Costello J, Comin-Colet J. Association between norepinephrine levels and abnormal iron status in patients with chronic heart failure: Is iron deficiency more than a comorbidity? J Am Heart Assoc. 2019;8:e010887. doi: 10.1161/JAHA.118.010887.

10. Silvestre OM, Goncalves A, Jr NW, Claggett B, Couper D, Eckfeldt JH, Pankow JS, Anker SD, Solomon SD. Ferritin levels and risk of heart failure–the Atherosclerosis Risk in Communities Study. Eur J Heart Fail. 2017;19:340–347. doi: 10.1002/ejhf.701.

11. Kobalava ZD, Lapshin AA, Galochkin SA. Prognostic significance of different iron deficiency criteria in patients with decompensated heart failure. Klinicheskaya farmakologiya i terapiya – Clinical Pharmacology and Therapy. 2023;32(4):30–35 (In Russ.)]. DOI: 10.32756/0869-5490-2023-4-30-35

12. Trukhan DI, Tarasova LV. Iron deficiency anemia: current issues of diagnosis, treatment and prevention. Gynecology. 2013;15(5). https://gynecology.orscience.ru/2079-5831/article/view/28281.

13. Beale A, Carballo D, Stirnemann J, Garin N, Agoritsas T, Serratrice J, Kaye D, Meyer Ph, Carballo S. Iron deficiency in acute decompensated heart failure. J Clin Med. 2019;8(10):1569. doi: 10.3390/jcm8101569.

14. Van Dalen DH, Kragten JA, Emans ME, van Ofwegen-Hanekamp CEE, Klaarwater CCR, Spanjers MHA, Hendrick R, van Deursen CThBM, Brunner-La Rocca HP. Acute heart failure and iron deficiency: a prospective, multicentre, observational study. ESC Heart Fail. 2022;9(1):398–407. doi: 10.1002/ehf2.13737.

15. Uyman OS, Pereverzeva AP. Prevalence and clinical significance of anemia and iron deficiency in patients with acute decompensated heart failure. In: Medicine of tomorrow. Chita: ChSMA; 2024:43–44 (In Russ.).

16. Palau P, Llàcer P, Domínguez E, Tormo JP, Zakarne R, Mollar A, Martínez A, Miñana G, Santas E, Almenar L, Fácila L, De La Espriella R, Núñez E, Manzano L, Bayés-Genís A, Núñez J. Iron deficiency and short-term adverse events in patients with decompensated heart failure. Clin Res Cardiol. 2021;110(8):1292–1298. doi: 10.1007/s00392-021-01832-z.

17. Mareev VYu, Begrambekova YuL, Mareev YuV, Kobalava ZhD, Karapetyan LV, Galochkin SA, Kazakhmedov ER, Lapshin AA, Garganeeva AA, Kuzheleva EA, Efremushkina AA, Kiseleva EV, Barbarash OL, Pecherina TB, Galyavich AA, Galeeva ZM, Baleeva LV, Koziolova NA, Veklich AS, Duplyakov DV, Maksimova MN, Yakushin SS, Smirnova EA, Sedykh EV, Shaposhnik II, Makarova NA, Zemlyanukhina AA, Skibitsky VV, Fendrikova AV, Skibitsky AV, Spiropoulos NA, Seredenina EM, Orlova YA, Eruslanova KA, Kotovskaya YuV, Tkacheva ON, Fedin MA. Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study. Kardiologiia. 2022;62(5):4-8. https://doi.org/10.18087/cardio.2022.5.n2083

18. Kobalava ZhD, Lapshin AA, Tolkacheva VV, Galochkin SA. Prevalence and clinical associations of iron deficiency in patients with decompensated heart failure, depending on the diagnostic criteria used for iron deficiency. Terapevticheskii arkhiv – Therapeutic Archive. 2022;94(7):844–849 (In Russ.). doi: 10.26442/00403660.2022.07.201716.

19. Smirnova EA, Sedykh EV, Yakushin SS, Subbotin SV. Prevalence and clinical significance of iron deficiency in patients with acute decompensated heart failure. Rossiyskiy kardiologicheskiy zhurnal – Russian Journal of Cardiology. 2023;28(8):5413 (In Russ.). doi: 10.15829/1560-4071-2023-5413.