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. 2022 Apr;9(2):874-884.
doi: 10.1002/ehf2.13850. Epub 2022 Feb 15.

Iron deficiency in heart failure patients: the French CARENFER prospective study

Alain Cohen-Solal  1 , Jean-Luc Philip  2 , François Picard  3 , Nicolas Delarche  4 , Guillaume Taldir  5 , Heger Gzara  6 , Anissa Korichi  7 , Jean-Noel Trochu  8 , Patrice Cacoub  9   10 ; CARENFER Study Group
Affiliations

Iron deficiency in heart failure patients: the French CARENFER prospective study

Alain Cohen-Solal et al. ESC Heart Fail. 2022 Apr.

Abstract

Aims: Iron deficiency (ID) is reported as one of the main co-morbidities in patients with chronic heart failure (CHF), which then influences quality of life and prognosis. The CARENFER study aimed to assess the prevalence of ID in a large panel of heart failure (HF) patients at different stages of the disease.

Methods and results: This prospective cross-sectional nationwide study was conducted in 48 medical units in France in 2019. Serum ferritin concentration and transferrin saturation (TSAT) index were determined in all eligible patients with a diagnosis of HF. ID diagnosis was based on the European Society of Cardiology (ESC) 2016 guidelines. Patients were classified as having either a decompensated HF or a CHF. Left ventricular ejection fraction (LVEF) was categorized as preserved (≥50%), mildly reduced (40-49%), or reduced (<40%). ID diagnosis was determined in 1661 patients, of whom 1475 could be classified as having a decompensated HF or a CHF. Patients' median age was 78 years. Decompensated HF represented 60.1% of cases. The overall prevalence of ID was 49.6% (47.1-52.1). In CHF and decompensated HF patients, respectively, ID prevalence was 39.0% (35.1-43.1) and 58.1% (54.7-61.4), P < 0.001; TSAT < 20% was respectively reported in 34.7% and 70.0% of patients (P < 0.001). Patients with preserved LVEF were more likely to have an ID (57.5%) compared with patients with mildly reduced (47.4%) or reduced LVEF (44.3%) (P < 0.001).

Conclusions: Iron deficiency was highly prevalent in patients with decompensated HF or CHF with preserved LVEF. ID prevalence defined by TSAT was higher than by the ESC criteria in decompensated HF patients, questioning the importance of ID definition to assess its prevalence.

Keywords: Adults; Cross-sectional studies; Epidemiology; Heart failure; Iron deficiency; Prevalence.

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Conflict of interest statement

P. Cacoub received grants from Alnylam and MSD; royalties from Iltoo; consulting fees from Vifor Pharma and Servier; honoraria from Vifor Pharma, Servier, and Alnylam; and support for attending meetings from Abbvie. J.N. Trochu received consulting fees and clinical research grant from Vifor Pharma for the present work; institutional grants from Novartis, Akcea, and Boston Scientific; consulting fees from Novartis, Bayer, Resmed, Astra Zeneca, and Abbott; and honoraria from Abbott and Novartis. A. Korichi has a full‐time position at Vifor Pharma Group. Alain Cohen Solal received in the last 3 years fees for expertises, boards, and studies from Novartis, Vifor Pharma, We Health, Bayer, Abbott, Merck, Astra Zeneca, Leo, Boehringer Ingelheim, and Sanofi. F. Picard received personal fees from Vifor Pharma for the present study. All remaining authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of CARENFER study. This graph displays the number (%) of patients with a documented stage of HF (decompensated vs. chronic) as well as a documented LVEF before admission. According to the reason for admission, patients were classified as having either a chronic HF or a decompensated HF corresponding to patients with acute or chronic HF with an unplanned hospitalization for decompensation. ID refers to the number of patients who were classified as iron deficient or not based on both iron saturation of transferrin and serum ferritin level. HF, heart failure; ID, iron deficiency; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Prevalence of iron deficiency (ID), absolute and functional ID, and TSAT < 20% according to the stage of heart failure (decompensated vs. chronic HF). Analysable population N = 1475. ESC, European Society of Cardiology; TSAT, iron saturation of transferrin.
Figure 3
Figure 3
Prevalence of iron deficiency (ID), absolute and functional ID, and TSAT < 20% according to left ventricular ejection fraction (LVEF). Analysable population N = 1502. LVEF before admission was categorized as preserved (≥50%), mildly reduced (40–49%), or reduced (<40%). ID was defined as a serum ferritin level < 100 μg/L or the combination of a serum ferritin level between 100 and 299 μg/L and a TSAT index < 20%; absolute ID was defined as a serum ferritin < 100 μg/L; and functional ID was defined as the combination of a serum ferritin level between 100 and 299 μg/L and a TSAT index < 20%. Prevalence estimates were compared between patients according to LVEF profile using the χ 2 test; an asterisk indicates a P‐value < 0.05. ESC, European Society of Cardiology; TSAT, iron saturation of transferrin.
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References

    1. van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, Maggioni AP, Voors AA. Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail 2014; 16: 103–111. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group . 2016 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 Heart J 2016; 37: 2129–2200 Available from. - PubMed
    1. Klip IT, Comin‐Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, Lok DJ, Rosentryt P, Torrens A, Polonski L, van Veldhuisen DJ, van der Meer P, Jankowska EA. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J 2013; 165: 575–582.e3. - PubMed
    1. Cohen‐Solal A, Damy T, Terbah M, Kerebel S, Baguet J‐P, Hanon O, Zannad F, Laperche T, Leclercq C, Concas V, Duvillié L, Darné B, Anker S, Mebazaa A. High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail 2014; 16: 984–991. - PubMed
    1. Sportouch L, Cautela J, Resseguier N, Pinto J, Ammar C, Gaubert M, Barraud J, Peyrol M, Laine M, Bonello L, Yvorra S, Paganelli F, Thuny F. Dynamic iron status after acute heart failure. Arch Cardiovasc Dis 2019; 112: 410–419. - PubMed

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