NEW YORK (Reuters Health) – Patients with chronic heart failure have a higher mortality risk or are more likely to undergo a heart transplant if they have low iron levels, investigators report in the European Heart Journal published online June 21.

The authors note that iron is involved in many biological processes apart from erythropoiesis, and that patients with chronic heart failure often have iron deficiency. “The prevalence and possible consequences of iron deficiency complicating CHF syndrome has only recently drawn attention,” they point out

To investigate the effect of iron status on mortality in CHF patients, Dr. Ewa A. Jankowska at Wroclaw Medical University, Poland, along with colleagues in several European centers, followed 546 such patients for up to 3 years. The subjects’ mean age was 55 and their average LV ejection fraction was 26%.

In this cohort, 37% had iron deficiency, defined as ferritin <100 mg/L, or 100–300 mg/L with transferrin saturation <20%. The researchers explain that they adopted this definition to account for both depletion of iron stores and impaired iron metabolism. Iron deficiency rates were higher in patients with anemia (57%) than in those without anemia (32%).

After a mean follow-up of 2 years, 153 participants had died and 30 had undergone heart transplantation. “In multivariable models, iron deficiency (but not anaemia) was related to an increased risk of death or heart transplantation (adjusted hazard ratio 1.58, p< 0.01),” Dr. Jankowska and colleagues report.

They note that a few recent studies have shown that the functional status of CHF patients can be improved by repletion of iron stores. The current results, they conclude, “may become the premises to consider an iron supplementation as a therapeutic approach in patients with CHF regardless of anaemia, aiming at an improvement in prognosis.”

Reference:
Iron deficiency: an ominous sign in patients with systolic chronic heart failure
Eur Heart J 2010.