[ad_1]

Credit: Cottonbro Studio/Pexels

A retrospective study evaluated the prognostic impact of anemia and iron deficiency over 30 months in a single-center registry in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).

More than half of the HFmrEF patients analyzed had anemia, and the presence of anemia was independently associated with an increased risk of all-cause mortality and HF-related readmission, even after multivariable adjustment. remained.

“The present study further highlights recent advances in the evaluation and treatment of iron deficiency in patients with HFmrEF,” wrote the research team, led by Michael Behnes of the First Department of Internal Medicine at Mannheim University Medical Center.

Risk stratification for heart failure remains complex given continued global demographic changes, with increasing numbers of patients with heart failure and associated comorbidities being reported.2 Anemia is particularly prevalent in heart failure, with nearly all patients hospitalized with heart failure presenting with a hematologic condition.3

Anemia is associated with poor long-term outcomes in patients with HFrEF and heart failure with preserved ejection fraction. On the other hand, conclusions regarding the prognostic impact of anemia in HFmrEF are limited in the current literature.1 Although the potential value of intravenous iron supplementation in HF has been reported in numerous trials, studies regarding HFmrEF are limited.

For this study, Behnes and colleagues sought to determine the association between anemia and iron deficiency in a retrospective registry of consecutive patients admitted with HFmrEF at an academic institution from January 2016 to December 2022.

The diagnosis of HFmrEF was determined based on the 2021 European Society of Cardiology guidelines for acute and chronic HF.Four The definition of anemia is based on World Health Organization (WHO) guidance, which states that hemoglobin levels are less than 13 g/dL for men and less than 12 g/dL for women. Iron deficiency was measured as ferritin levels <100 μg/L or transferrin saturation <20% between 100 and 299 μg/L.

All-cause mortality during a median follow-up of 30 months was the primary endpoint, and secondary endpoints included all HF-related readmissions during follow-up.1 Heart failure-related hospitalizations were considered readmissions due to worsening heart failure requiring intravenous diuretic treatment.

After identifying 2,228 patients admitted with HFmrEF during the study period, exclusions left a final cohort of 2,154 patients with MFmrEF. The median hemoglobin level was 12.2 g/dL, and the prevalence of anemia was 51.7%. Those with anemia were older (median, 78 years vs. 72 years; P = .001), higher rates of hospitalization for decompensated heart failure <12 months (13.7% vs. 7.5%; p = .001), and higher rates of chronic kidney disease (44.5% vs. 17.2%; p = .001). 001). P = .002), higher than those without conditions.

Analysis showed that the presence of anemia was associated with an increased risk of all-cause mortality (44% vs. 18%; hazard ratio) during a median follow-up of 30 months. [HR]3.021; 95% CI, 2.552 to 3.576. P = .001), meeting the primary endpoint. Anemia was also associated with the risk of readmission due to worsening heart failure (18% vs. 8%; HR, 2.351; 95% CI, 1.819 – 3.040; 95% CI, 1.819 – 3.040; P = .001) and met the secondary endpoint after 30 months.

After multivariate adjustment, Behnes et al showed that the presence of anemia at 30 months was still independently associated with increased risk of both the primary and secondary endpoints (all endpoints) P = .001).

Of the 1,113 patients identified as anemic, iron levels were measured in only 296 patients (27%). The corresponding prevalence of iron deficiency was 50%. More iron-deficient patients had previous congestive heart failure (51.7% vs. 36.2%; P = .007), hospitalized for decompensated heart failure <12 months (23.8% vs. 12.1%; P = .008).

At 30 months, there was no difference in risk of all-cause mortality between those with and without iron deficiency (44% vs 48%, 95% CI, 0.831-1.162; 95% CI, 0.831-1.162, 95% CI , 0.831-1.162, 95% CI, 0.831-1.162 P .279). However, those with iron deficiency had an increased risk of heart failure-related readmission after 30 months (25% vs. 15%; HR, 1.746; 95% CI, 1.024 to 2.976; 95% CI, 1.024 to 2.976; 95% CI, 1.024-2.976). P = .038).

Because iron status was measured in about a quarter of patients with only heart failure and associated anemia, Behnes and colleagues suggested that a gap exists between guideline recommendations and routine clinical care.

“The present study therefore supports the need for better measurement of iron status in patients with HFmrEF,” the researchers wrote.

References

  1. Schupp T, Weidner K, Reinhardt M, et al. Effects of anemia and iron deficiency in heart failure with mildly reduced ejection fraction. Euro J Clin Investment Published online on April 10, 2024. doi:10.1111/eci.14205
  2. Khan MS, Samman Tahhan A, Vaduganathan M, et al. Trends in the prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail. 2020;22(6):1032-1042. doi:10.1002/ejhf.1818
  3. Pintail A, Behon A, Velez B, et al. Prognostic value of anemia in patients with preserved, mildly reduced, and recovered ejection fraction. Diagnosis (Basel). 2022;12(2):517. Published February 17, 2022. doi:10.3390/diagnostics12020517
  4. McDonough TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure [published correction appears in Eur Heart J. 2021 Oct 14;:]. euro heart j. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368

[ad_2]

Source link