Investigation of iron deficiency in patients with congestive heart failure: A medical practice that requires greater attention

• Published in: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 36; no. 3; p. 249
• Main Authors: Belmar Vega, Lara, de Francisco, Alm, Albines Fiestas, Zoila, Serrano Soto, Mara, Kislikova, María, Seras Mozas, Miguel, Unzueta, Mayte García, Arias Rodríguez, Manuel
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-05-2016
• Subjects: Aged; Aged, 80 and over; Anemia, Iron-Deficiency - etiology; Cardio-Renal Syndrome - blood; Female; Ferritins - blood; Heart Failure - blood; Heart Failure - complications; Humans; Iron - blood; Iron - deficiency; Male; Retrospective Studies; Sex Distribution; Transferrin - analysis; Health-related quality of life; Síndrome cardio-renal; Anaemia; Anemia; Congestive heart failure; Iron deficiency; Deficiencia de hierro; Exercise intolerance; Cardiorenal syndrome; Calidad de vida relacionada con la salud; Intolerancia al ejercicio; Insuficiencia cardiaca congestiva; Renal failure; Insuficiencia renal
• ISSN: 1989-2284
• DOI: 10.1016/j.nefro.2016.03.001

Iron deficiency in congestive heart failure (CHF), with or without concomitant anaemia, is associated with health-related quality of life, NYHA functional class, and exercise capacity. Prospective, randomised studies have demonstrated that correcting iron deficiency improves the quality of life and functional status of patients with CHF, including those who do not have anaemia.
The aim of this study was to analyse how frequently these iron parameters are tested and thus determine the extent to which this quality improvement tool has been implemented in patients admitted with CHF.
Retrospective observational study of patients from a university hospital diagnosed with CHF on admission between 01/01/2012 and 11/06/2013.
Iron parameters were tested in 39% (324) of the 824 patients analysed. There was no significant difference in age between the patients whose iron was tested and those whose iron was not tested, but the difference in terms of gender was significant (P=.007). Glomerular filtration rate and haemoglobin, were significantly lower in the group of patients whose iron was tested (P<.001). The proportion of patients with anaemia, renal failure or both was significantly higher in the group of patients who had iron tests (P<.001). Of the 324 patients whose iron parameters were tested, 164 (51%) had iron deficiency. There were no differences between patients with and without iron deficiency in terms of age or gender. The iron parameters in both groups, ferritin and transferrin saturation index were significantly lower among the patients with iron deficiency (P<.001). The glomerular filtration rate values were significantly lower in patients with no iron deficiency (P<.001). Significant differences were also observed between those with and without iron deficiency in the proportion of patients with renal failure (79 vs. 66%, respectively, P=.013), but not in terms of haemoglobin concentration.
Congestive heart failure is very frequently associated with anaemia, iron deficiency and renal failure. Despite the fact that correcting iron deficiency is known to improve symptoms, testing of iron parameters in patients admitted with CHF is not performed as often as it should be.