LAUSR

BACKGROUND Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. METHODS We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65-79) years, 70% men, 51% HFrEF) one year apart. ID was defined as serum iron ≤13 μmol/L and anaemia as haemoglobin <13.0 g/dL for men or <12.0 g/dL for women. FAIR-HF criteria for ID were also considered. RESULTS At baseline, 10% had anaemia without ID, 23% had ID without anaemia, 20% had both and 47% had neither. Percentages changed little over one year, but 157 (30%) patients had new-onset ID, 104 (16%) new-onset anaemia, whilst ID resolved in 173 (44%) and anaemia in 63 (23%). Compared to those who remained iron replete (iron >13 μmol/L), mortality was higher in those with persistent or incident ID at 1 year (respectively HR 1.81; [1.23-2.67] and HR 1.40; [0.91-2.14]) in multivariable models (p=0.02). Compared to persistent ID, resolution of ID was associated with a lower mortality (HR 0.61 [0.44-0.86]; p=0.004). Changes in ID defined by FAIR-HF criteria were not similarly associated with mortality. Anaemia was associated with a poor outcome even if it resolved. CONCLUSIONS The prevalence and incidence of ID and anaemia are high in chronic heart failure but so is the rate of resolution. Persistent or incident ID, defined by a serum iron ≤13 μmol/L, is associated with higher mortality and resolution of ID with lower mortality.