ESC Heart Failure (Apr 2025)

Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights

  • Abdullahi Ahmed Mohamed,
  • Daniel Mølager Christensen,
  • Milan Mohammad,
  • Christian Torp‐Pedersen,
  • Lars Køber,
  • Emil Loldrup Fosbøl,
  • Tor Biering‐Sørensen,
  • Morten Lock Hansen,
  • Mariam Elmegaard Malik,
  • Nina Nouhravesh,
  • Charlotte Anderrson,
  • Morten Schou,
  • Gunnar Gislason

DOI
https://doi.org/10.1002/ehf2.15149
Journal volume & issue
Vol. 12, no. 2
pp. 1346 – 1357

Abstract

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Abstract Aims Iron deficiency (ID) is prevalent in chronic heart failure (HF) but lacks a consensus definition. This study evaluates the prevalence and the prognostic impact of ID using different criteria on all‐cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new‐onset chronic HF. Methods In this nationwide registry‐based cohort, we explored four definitions of ID: the current European Society of Cardiology (ESC) guidelines [ferritin 13 μmol/L and TSAT > 20%. Regardless of anaemia status, ID defined by TSAT < 20% or serum iron ≤13 μmol/L was associated with all‐cause mortality [non‐anaemic, hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.30–1.89 and HR: 1.47, 95% CI: 1.24–1.73; anaemic, HR: 1.22, 95% CI: 1.07–1.38 and HR: 1.25, 95% CI: 1.09–1.44, respectively] and cardiovascular mortality (non‐anaemic, HR: 2.21, 95% CI: 1.59–3.06 and HR: 1.47, 95% CI: 1.12–1.95; anaemic, HR: 1.37, 95% CI: 1.11–1.69 and HR: 1.28, 95% CI: 1.02–1.61, respectively), as well as increased risk of first hospitalization for HF (non‐anaemic, HR: 1.28, 95% CI: 1.09–1.1.50 and HR: 1.27, 95% CI: 1.10–1.46; anaemic, HR: 1.25, 95% CI: 1.08–1.44 and HR: 1.22, 95% CI: 1.05–1.42, respectively). ID defined by ESC guidelines was associated with all‐cause and cardiovascular mortality only in non‐anaemic patients (HR: 1.41, 95% CI: 1.18–1.1.70 and HR: 1.58, 95% CI: 1.18‐2.12.). Furthermore, the ESC guideline definition was associated with increased risk of first hospitalization for HF, regardless of anaemia status (non‐anaemic, HR: 1.26, 95% CI: 1.08–1.1.47; anaemic, HR: 1.34, 95% CI: 1.17–1.53). Conclusions ID, when defined by TSAT < 20% or serum iron ≤13 μmol/L, is associated with increased risk of all‐cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new‐onset chronic HF, regardless of anaemia status. Conversely, ID defined as ESC guidelines is associated with all‐cause and cardiovascular mortality only in non‐anaemic patients.

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