PREVALENCE OF IRON DEFICIENCY ANEMIA IN HEART FAILURE IN A TERTIARY CARE HOSPITAL OF NORTH INDIA
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Keywords
Heart failure, Anemia, Iron deficiency, Left ventricular dysfunction, NYHA class
Abstract
Background: Heart failure (HF) is a major public health concern worldwide and is frequently complicated by anemia, especially iron deficiency anemia (IDA), which worsens outcomes.
Objectives: To determine the prevalence of iron deficiency anemia in patients with chronic heart failure, to analyze the pattern of anemia associated with HF, and to correlate the severity of anemia with functional class of HF.
Methods: A prospective observational study was conducted over 2 years at SKIMS, Srinagar. A total of 359 patients with symptomatic chronic HF and left ventricular ejection fraction (LVEF) <40% were enrolled. Clinical evaluation, laboratory investigations including complete blood count, red cell indices, and iron studies (serum ferritin, transferrin saturation, TIBC) were performed. Anemia was defined by WHO criteria, and iron deficiency was categorized as absolute or functional.
Results: The mean age of patients was 59.2±7.32 years; 58.8% were males. Overall prevalence of anemia was 49.6%, with females more affected (53.4% vs. 46.9%, p=0.228). Iron deficiency was seen in 48.7% patients, with absolute ID predominating (75.0%). Iron deficiency anemia was documented in 37.3% of patients, more common in females (40.5%). Anemia prevalence increased significantly with advancing age in males (p=0.039). Severity of anemia correlated with higher NYHA class and lower eGFR (p<0.001).
Conclusion: Iron deficiency anemia is highly prevalent among patients with chronic HF, particularly in elderly and female patients. Routine evaluation of iron status is essential, as timely correction may improve functional outcomes.
References
2. Sandhu A, Soman S, Hudson M, and Besarab A. Managing anemia in patients with chronic heart failure: what do we know? Vascular Health and Risk Management, 2010; 6(1): 237–252.
3. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990‐2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789-58.
4. Huffman MD and Prabhakaran D. Heart failure: Epidemiology and prevention in India. Natl Med J India. 2010; 23(5): 283–88.
5. Ponikowski P, Voors AA, Anker SD et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016; 18: 891-975.
6. Yancy CW, Jessup M, Bozkurt B et al. ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on practice guidelines. 2013.
7. van Riet EE Hoes AW Wagenaar KP Limburg A Landman MA Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016; 18: 242-252.
8. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011; 8: 30-41.
9. Owan TE Hodge DO Herges RM Jacobsen SJ Roger VL Redfield MM Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355: 251-259.
10. Gerber Y, Weston SA, Redfield MM et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015; 175: 996-1004.
11. Stevenson LW. Heart failure with better ejection fraction: a modern diagnosis. Circulation. 2014; 129: 2364-2367.
12. Basuray A, French B, Ky B et al. Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes. Circulation. 2014; 129: 2380-2387.
13. Beutler E and Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006; 107: 1747–1750.
14. National Kidney Foundation KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;5:S1–S3.
15. Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013; 34: 816-29.
16. Testa M, Yeh M, Lee P, Fanelli R, Loperfido F, Berman JW, et al. Circulating levels of cytokines and their endogenous modulators in patients with mild to severe congestive heart failure due to coronary artery disease or hypertension. J Am Coll Cardiol 1996; 28: 964-71.
17. Gunawardena S, Dunlap ME. Anemia and Iron Deficiency in Heart Failure. Curr Heart Fail Rep 2012; 9: 319-27.
18. Silverberg DS, Wexler D, Schartz D. Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure? Int J Mol Sci 2015; 16: 14056-74.
19. Jankowska EA, Malyszko J, Ardehali H, Koc-Zorawska E, Banasiak W, von Haehling S, et al. Iron status in patients with chronic heart failure. Eur Heart J 2013;34:827-34.
20. Fitzsimons S, Doughty RN. Iron deficiency in patients with heart failure. Eur Heart J Cardiovasc Pharmacother 2015; 1: 58-64.
21. Murphy CL, McMurray JJ. Approaches to the treatment of anemia in patients with chronic heart failure. Heart Fail Rev 2008; 13: 431-8.
22. Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anemia in patients with chronic heart failure. Eur Heart J 2005; 26: 2232-7.
23. Felker GM, dams F, Gattis W , O’Connor CM. Anemia as a Risk Factor and Therapeutic target in heart failure. J Am Coll Cardiol 2004; 44: 959-66.
24. Kilicgedik A, Dundar C, Tigen MK. Anemia in heart failure. Anadolu Kardiyol Derg 2012; 12: 65-70.
25. Tang YD, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation 2006; 113:
26. Anand IS. Heart failure and anemia: mechanisms and pathophysiology. Heart Fail Rev 2008; 13: 379-86.
27. Westenbrink BD, Voors AA, de Boer RA, Schuringa JJ, Klinkenberg T, van der Harst P, et al. Bone marrow dysfunction in chronic heart failure patients. Eur J Heart Fail 2010; 12: 676-84.
28. Silverberg DS, Wexler D, Blum M, and Laina A. The cardio renal anemia syndrome: correcting anemia in patients with resistant congestive heart failure can improve both cardiac and renal function and reduce hospitalizations. Clinical Nephrology, 2003;60(1): S93–S102.
29. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Lüscher TF et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009; 361(25): 2436-48.
30. Confirm HF. Iron deficient heart failure patients see improvement with intravenous supplementation Hot Line I: Cardiovascular disease: novel therapies 30 Aug 2014.
31. van Veldhuisen DJ, Ponikowski P, van der Meer P, Metra M, Böhm M, Doletsky A et al. Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency. Circulation. 2017; 136(15):1374-83.
32. Sharma SK, Agarwal SK. Prevalence and spectrum of iron deficiency in heart failure patients in south Rajasthan. Indian Heart J. 2016 Jul-Aug; 68(4): 493–497.
33. Negi PC, Dev M, Paul P, Pal Singh D, Rathoure S, Kumar R et al. Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry. Indian Heart J. 2018 Dec; 70 Suppl 3 (Suppl 3): S182-S188.
34. Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J. 2013 Apr;165(4):575-582.e3.
35. Singh B, Bajaj N, Singh P, Kumar Ghosh A, Anathakrishnan R, Singh N. Iron deficiency in patients of heart failure with reduced ejection fraction. Med J Armed Forces India. 2022 Oct;78(4):463-68.
36. Chobufo MD, Rahman E, Gayam V, Bei Foryoung J, Agbor VN, Farah F et al. Prevalence and association of iron deficiency with anemia among patients with heart failure in the USA: NHANES 2017-2018. J Community Hosp Intern Med Perspect. 2021 Jan 26; 11(1):124-127.
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Dr. Suheel Ahmad Mir
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
Dr. Imran Hafeez
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
Dr. Najeeb Ahmad
MD, Medicine, DNB Scholar, Gastroenterology and Hepatology), Govt. Medical College, Srinagar, Jammu and Kashmir, India
Dr. Aamir Rashid
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
Dr. Mir Misba Gull
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
Dr. Jawad Iqbal Rather
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India