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Observational Study
. 2017 Jun;106(6):436-443.
doi: 10.1007/s00392-016-1073-y. Epub 2017 Feb 22.

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

Stephan von Haehling  1 , Uwe Gremmler  2 , Michael Krumm  2 , Frank Mibach  3 , Norbert Schön  4 , Jens Taggeselle  5 , Johannes B Dahm  6 , Christiane E Angermann  7
Affiliations
Observational Study

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

Stephan von Haehling et al. Clin Res Cardiol. 2017 Jun.

Abstract

Background: Iron deficiency (ID) and anaemia are common in heart failure (HF). The prospective, observational PReP registry (Prävalenz des Eisenmangels bei Patienten mit Herzinsuffizienz) studied prevalence and clinical impact of ID and anaemia in HF outpatients attending cardiology practices in Germany.

Methods and results: A total of 42 practices enrolled consecutive patients with chronic HF [left ventricular ejection fraction (LVEF) ≤45%]. ID was defined as serum ferritin <100 µg/l, or serum ferritin ≥100 µg/l/<300 µg/l plus transferrin saturation <20%, and anaemia as haemoglobin <13 g/dl (12 g/dl) in men (women). Exercise capacity was assessed using spiroergometry (69.4%) or 6-min walk test (30.4%). Amongst 1198 PReP-participants [69.0 ± 10.6 years, 25.3% female, New York Heart Association (NYHA) class 2.4 ± 0.5, LVEF 35.3 ± 7.2%], ID was found in 42.5% (previously unknown in all), and anaemia in 18.9% (previously known in 4.8%). ID was associated with female gender, lower body weight and haemoglobin, higher NYHA class and natriuretic peptide (NP) levels (all p < 0.05). ID was also more common in anaemic than non-anaemic patients (p < 0.0001), and 9.8% of PrEP-participants had both, ID and anaemia. On spiroergometry, ID independently predicted maximum exercise capacity even after multivariable adjustment, including anaemia (p = 0.0004). In all PrEP-participants, ID predicted reduced physical performance (adjusted for age, gender, anaemia, serum creatinine, C-reactive protein, LVEF, and NP level).

Conclusions: Despite high prevalence, ID was previously unknown in all PrEP-participants, and anaemia was often unappreciated. Given the clinical relevance, treatability, and independent association with reduced physical performance, ID should be considered more in real-world ambulatory healthcare settings and ID-screening be advocated to cardiologists in such populations.

Keywords: Anaemia; Exercise capacity; Heart failure; Iron deficiency; Prevalence.

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Conflict of interest statement

Funding

This work was supported by Vifor Pharma.

Conflict of interest

SvH has received consulting honoraria from Vifor Pharma and lecture fees from Amgen. C.E. Angermann acknowledges grant and other support, speaker honoraria, and consultancy fees from Vifor Pharma. All other authors have no conflicts of interest relevant to this manuscript to disclose.

Figures

Fig. 1
Fig. 1
NYHA class according to baseline status being iron-deficient, anaemic, both or none of the two. ANOVA p < 0.0001
Fig. 2
Fig. 2
NYHA class according to baseline status being iron-deficient, anaemic, both or none of the two, devided by gender. Male blue bars, female red bars. Number above the bars represents n numbers in each group
See this image and copyright information in PMC

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