Effects of Iron Deficiency Anemia on Functional Status of Patients of Heart Failure with Reduced Ejection Fraction
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-7.13980Keywords:
Anemia, Ejection Fraction, Exercise Test, Iron-Deficiency, Quality of LifeAbstract
Objective: To evaluate effects of iron deficiency anaemia on functional status of patients with heart failure with reduced ejection fraction (HfrEF).
Study Design: Analytical cross-sectional study.
Place and Duration of Study: Department of Medicine, Combined Military Hospital, Multan Pakistan, from Dec 2024 to Sep 2025.
Methodology: A total of 320 adult patients with chronic HFrEF were enrolled through consecutive sampling. Functional status was assessed by New York Heart Association (NYHA) class, six-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Iron deficiency was defined as serum ferritin <100 µg/L or 100–299 µg/L with transferrin saturation (TSAT) <20%. Haemoglobin, ferritin and TSAT were measured. Comparisons between IDA (Group-A) and non-IDA (Group-B) groups were performed. Multivariable linear regression was applied to identify independent predictors of 6MWT distance.
Results: Iron deficiency was observed in 196(61.3%) patients. Compared to non-deficient patients, those with IDA had lower mean haemoglobin (11.17±0.95 vs. 13.54±0.87 g/dL, p<0.001), ferritin (63.95 vs. 170.70 µg/L, p<0.001), TSAT (15.65% vs. 28.35%, p<0.001), 6MWT distance (280.98±44.56 vs. 303.32±42.51 m, p<0.001), and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (42.72±8.91 vs. 47.28±8.76, p<0.001). Regression analysis showed transferrin saturation (β=0.18, p=0.015) and haemoglobin (β=0.23, p=0.011) as independent predictors of six-minute walk test (6MWT) distance.
Conclusion: IDA significantly impairs functional capacity and quality of life in patients with HFrEF. Routine screening and correction of iron deficiency should be integrated into heart failure management to improve outcomes.
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References
1. Gardner W, Razo C, McHugh T. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol 2023; 10(9): 713-734.
https://dx.doi.org/10.1016/S2352-3026(23)00160-6
2. Sharma J, Sriram D, Sengupta A, Rajeshwari PN. Assessing the prevalence of iron deficiency anemia and risk factors among children and women: A case study of rural uttar pradesh. Clin Epidemiol Glob Health 2024; 26: 101545.
https://doi.org/10.1016/j.cegh.2024.101545
3. Sun J, Wu H, Zhao M, Magnussen CG, Xi B. Prevalence and changes of anemia among young children and women in 47 low- and middle-income countries, 2000-2018. EClinicalMedicine 2021; 41(1): 101136.
https://dx.doi.org/10.1016/j.eclinm.2021.101136
4. Rashid AM, Khan MS, Fudim M, DeWald TA, DeVore A, Butler J. Management of Heart Failure with Reduced Ejection Fraction. Curr Probl Cardiol 2023; 48(5): 101596.
https://doi.org/10.1016/j.cpcardiol.2023.101596
5. Jishnu M, Wilde MI, Rocca HPBL, Emans ME, De A, Siegers CEP, et al. Newly diagnosed heart failure with reduced ejection fraction: timing, sequencing, and titration of guideline-recommended medical therapy. Eur Heart J 2025; 46(25): 2394-2405. https://doi.org/10.1093/eurheartj/ehaf244
6. Jishnu M, Clephas BRD, La Rocca BL, Brugts JJ. Guideline-directed medical therapy for HFrEF: sequencing strategies and barriers for life-saving drug therapy. Heart Fail Rev 2023; 28(5): 1221-1234. https://dx.doi.org/10.1007/s10741-023-10325-2
7. Clephas PR, Malgie J, Schaap J, Koudstaal S, Emans M, Linssen GC, et al. Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF. ESC Heart Fail 2023; 11(1): 550–559.
https://dx.doi.org/10.1002/ehf2.14604
8. Özmen M. Iron Deficiency Anemia and Mortality Rate in Heart Failure with Reduced Ejection Fraction. J Updates Cardiovasc Med 2025; 13(2): 72–80.
https://dx.doi.org/10.32596/jucvm.galenos.2025.2024-27-94
9. Solberg A, Reikvam H. Iron Status and Physical Performance in Athletes. Life 2023; 13(10): 2007.
https://dx.doi.org/10.3390/life13102007
10. Keller K, Friedrich O, Treiber J, Quermann A, Friedmann-Bette B. Iron deficiency in athletes: prevalence and impact on VO2 peak. Nutrition 2024; 126: 112516.
https://doi.org/10.1016/j.nut.2024.112516
11. Myhre PL, Øyunn K, Berge, Morten G, Lars G, Stein Ø. Changes in 6‐min walk test is an independent predictor of death in chronic heart failure with reduced ejection fraction. Eur J Heart Fail 2024; 26(12): 2608–2615.
https://dx.doi.org/10.1002/ejhf.3391
12. Mir A, Hafeez I, Ahmad N, Rashid A, Gull MM, Rather JI. Prevalence Of Iron Deficiency Anemia In Heart Failure In A Tertiary Care Hospital Of North India. J Popul Ther Clin Pharmacol 2024; 31(7): 1–10. https://doi.org/10.53555/z8pj2645
13. Spertus J, Jones P, Sandhu A. Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76(20): 2379–2390. https://doi.org/10.1016/j.jacc.2020.09.542
14. Akbarpour E, Paridar Y, Mohammadi Z, Mard A, Danehchin L, Abolnezhadian F, et al. Anemia prevalence, severity, types, and correlates among adult women and men in a multiethnic Iranian population: the Khuzestan Comprehensive Health Study. BMC Public Health 2022; 22(1): 1-13.
https://doi.org/10.1186/s12889-022-12512-6
15. Von Haehling S. Iron deficiency in heart failure: Epidemiology, diagnostic criteria and treatment modalities. ESC Heart Fail 2024; 12(2): 723–726.
https://dx.doi.org/10.1002/ehf2.15157
16. Singer CE, Vasile CM, Popescu M, Popescu AIS, Marginean IC, Iacob GA, et al. Role of Iron Deficiency in Heart Failure—Clinical and Treatment Approach: An Overview. Diagnostics 2023; 13(2): 304.
https://dx.doi.org/10.3390/diagnostics13020304
17. Masini G, Graham F, Pellicori P, Cleland J, Cuthbert J, Kazmi S, et al. Criteria for Iron Deficiency in Patients With Heart Failure. JACC 2022; 79(4): 341–351.
https://doi.org/10.1016/j.jacc.2021.11.039
18. Graham FJ, Guha K, Cleland JG, Kalra PR. Treating iron deficiency in patients with heart failure: what, why, when, how, where and who. Heart 2024; 110(20): 1201–1207.
https://doi.org/10.1136/heartjnl-2022-322030
19. Ebner N, Jankowska EA, Ponikowski P, Lainscak M, Elsner S, Sliziuk V, et al. The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure. Int J Cardiol 2016; 205: 6–12.
https://doi.org/10.1016/j.ijcard.2015.11.178
20. Martens P. The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction. Card Fail Rev 2022; 8(6): 1-7.
https://dx.doi.org/10.15420/cfr.2021.26
21. Packer M, Anker SD, Butler J, John GF, Cleland PR, Mentz RJ, et al. Redefining Iron Deficiency in Patients With Chronic Heart Failure. Circulation 2024; 150(2): 151-161.
https://doi.org/10.1161/CIRCULATIONAHA.124.068883
22. Khan MS, Anker SD, Friede T, Jankowska EA, Metra M, Piña IL, et al. Minimal Clinically Important Differences in 6-Minute Walk Test in Patients With HFrEF and Iron Deficiency. J Card Fail 2022; 29(5): 760–770.
https://doi.org/10.1016/j.cardfail.2022.10.423
23. Alcaide A, Garay A, L Alcoberro, Jiménez-Marrero S, Yun S, Tajes M, et al. Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction. J Clin Med 2020; 9(4): 1199.
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