Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry

Abstract

Background: The study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF). Methods: Serum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables. Results: Iron deficiency and anemia were prevalent in 58.8% (52.2%–65.1%) and 35.8% (29.8%–42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9–6.5)], history of bleeding [OR 11.7 (95% CI 1.4–101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4–4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40–6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97–0.99)], history of bleeding [OR 13.0 (95% CI 2.3–70.9)], and female gender [OR 2.9 (95% CI 1.5–5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70–0.96) and transferrin saturation (OR 0.98 (95% CI 0.96–0.99)] had a significant inverse association with symptoms of advanced heart failure. Conclusion: Iron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure. Keywords: Nonischemic systolic heart failure, Heart failure with reduced ejection fraction, Iron deficiency, Anemia, Risk factor, Advanced heart failure