Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights
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...
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| Format: | Article |
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Wiley
2025-04-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15149 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Abdullahi Ahmed Mohamed |
| collection | DOAJ |
| description | 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 <100 ng/mL or ferritin 100–299 ng/mL and transferrin saturation (TSAT) <20%], ferritin level <100 ng/mL, TSAT < 20% and serum iron ≤13 μmol/L. Patients were identified through the Danish Heart Failure Registry. Results Of 9477 new‐onset chronic HF patients registered in the Danish Heart Failure Registry from April 2003 to December 2019, we observed ID prevalence rates ranging from 35.8% to 64.3% depending on the ID definition used. Among patients with ID defined by iron ≤13 μmol/L or TSAT < 20%, 26% and 15.5%, respectively, did not meet the ESC guidelines definition for ID. Conversely, 11% of patients meeting the ESC criteria exhibited serum iron >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. |
| format | Article |
| id | doaj-art-e52bbc96565949f7a2e97481109795f7 |
| institution | DOAJ |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-e52bbc96565949f7a2e97481109795f72025-08-20T02:55:48ZengWileyESC Heart Failure2055-58222025-04-011221346135710.1002/ehf2.15149Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insightsAbdullahi Ahmed Mohamed0Daniel Mølager Christensen1Milan Mohammad2Christian Torp‐Pedersen3Lars Køber4Emil Loldrup Fosbøl5Tor Biering‐Sørensen6Morten Lock Hansen7Mariam Elmegaard Malik8Nina Nouhravesh9Charlotte Anderrson10Morten Schou11Gunnar Gislason12Department of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Nordsjællands Hospital Hillerød DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Rigshospitalet Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Rigshospitalet Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital ‐ Herlev and Gentofte Hospital Copenhagen DenmarkAbstract 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 <100 ng/mL or ferritin 100–299 ng/mL and transferrin saturation (TSAT) <20%], ferritin level <100 ng/mL, TSAT < 20% and serum iron ≤13 μmol/L. Patients were identified through the Danish Heart Failure Registry. Results Of 9477 new‐onset chronic HF patients registered in the Danish Heart Failure Registry from April 2003 to December 2019, we observed ID prevalence rates ranging from 35.8% to 64.3% depending on the ID definition used. Among patients with ID defined by iron ≤13 μmol/L or TSAT < 20%, 26% and 15.5%, respectively, did not meet the ESC guidelines definition for ID. Conversely, 11% of patients meeting the ESC criteria exhibited serum iron >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.https://doi.org/10.1002/ehf2.15149anaemiadiagnosisheart failureiron deficiencymortalityprevalence |
| spellingShingle | 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 Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights ESC Heart Failure anaemia diagnosis heart failure iron deficiency mortality prevalence |
| title | Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights |
| title_full | Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights |
| title_fullStr | Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights |
| title_full_unstemmed | Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights |
| title_short | Prognostic impact of iron deficiency in new‐onset chronic heart failure: Danish Heart Failure Registry insights |
| title_sort | prognostic impact of iron deficiency in new onset chronic heart failure danish heart failure registry insights |
| topic | anaemia diagnosis heart failure iron deficiency mortality prevalence |
| url | https://doi.org/10.1002/ehf2.15149 |
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