Correction of iron deficiency in hospitalized heart failure patients does not improve patient outcomes
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ORIGINAL ARTICLE
Correction of iron deficiency in hospitalized heart failure patients does not improve patient outcomes Ronak H. Mistry 1
&
Andrew Kohut 2 & Patricia Ford 3
Received: 30 May 2020 / Accepted: 3 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Heart failure (HF) has an estimated prevalence of 1–2% in the world’s population and up to 10% of patients age 65 and above. Iron deficiency (ID) in HF has been shown to be an independent contributor of increased mortality and poorer quality of life and has been associated with increased rates of hospitalization. Estimates are varied, but it is believed that as many as 30–83% of HF patients have ID, often without overt anemia, therefore making diagnosis more difficult. Well-established large studies have shown intravenous iron (IVFe) supplementation in HF patients is superior to an oral route, though these guidelines were developed for the chronic HF patients in the outpatient setting. For patients who are frequently hospitalized for HF, their inpatient stays may present an opportunity to diagnose ID. We previously showed that ID is underdiagnosed in the inpatient setting. To date, limited studies investigate long-term outcomes in hospitalized HF patients diagnosed with ID who are treated with IVFe compared to those who are not. In this retrospective analysis, we assessed 1-year readmission rates and mortality outcomes in patients who were diagnosed with ID while admitted for HF and subsequently received IVFe versus those who did not on their initial admission. These data suggest that there is no significant reduction in readmissions for HF or mortality between those patients who received IVFe and those who did not. Keywords Iron deficiency . Heart failure . Anemia . Intravenous iron
Background Heart failure (HF) is a chronic medical condition with an estimated prevalence of 1–2% in the world’s population and up to 10% of patients age 65 and above [1, 2]. A well-established association with HF is anemia, and furthermore, anemia increases mortality rates in HF patients [3]. The etiology of anemia in the majority of cases is iron deficiency (ID) [4]. In fact, as many as 30–83% of HF
* Ronak H. Mistry [email protected] 1
Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, 800 Spruce Street, Philadelphia, PA 19107, USA
2
Penn Heart and Vascular Center Washington Square, Pennsylvania Hospital of the University of Pennsylvania, 800 Walnut Street, Philadelphia, PA 19107, USA
3
Abramson Cancer Center, Pennsylvania Hospital of the University of Pennsylvania, 230 West Washington Square, Philadelphia, PA 19106, USA
patients are believed to have ID, often without concurrent overt anemia [2, 5–7]. Thus, ID continues to be underrecognized and undertreated. Identification and correction of ID are critical for patients as it results in impaired exercise tolerance, poorer quality of life, and increased rates of hospitalization for HF [8]. Furthermore, ID is also an independent
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