Iron Deficiency in Secondary Care: Chronic Heart failure

Although many aspects of chronic heart failure (CHF) can be successfully managed, the prognosis for CHF patients typically remains poor. The challenging clinical outcomes in CHF emphasize the importance of identifying, and treating, modifiable co-morbid factors that independently accelerate the progression of CHF.

Iron deficiency is one such factor, and it is linked to both disease severity and mortality in patients with CHF.1 Despite common expectations to the contrary, in this scenario, iron deficiency exerts a greater influence on overall prognosis than anaemia.1–3

Prevalence of iron deficiency in patients with CHF


Iron deficiency affects approximately 50% of CHF patients.4 Several processes are thought to be involved in causing iron deficiency in these patients, including:

  • Malabsorption and inflammation in the gastrointestinal tract5
  • Impaired erythroposiseis,6 and
  • Functional iron deficiency.6

An estimated 37–50% of patients with chronic heart failure are iron deficient, defined as a serum ferritin level <100 µg/L or 100–300 µg/L with a transferrin saturation <20%.2,3,7,8,9

Patient prognosis & clinical benefits from correcting iron deficiency in CHF


Patients with both CHF and iron deficiency have an elevated risk of heart transplantation, experience increased morbidity, and typically suffer from reduced exercise capacity and quality of life.1,6,7 This reduction in quality of life is comparable to that observed with other chronic medical conditions, such as diabetes, arthritis and chronic lung disease. Importantly, correcting iron deficiency in patients with CHF has been shown to elicit a significant improvement in symptoms, e.g. shortness of breath and fatigue, as well as exercise performance and quality of life.1,8,9

Iron deficiency has also been repeatedly and independently associated with a marked increase in mortality in patients with heart disease (see Figure 1).1–3,9

Figure 1: Cumulative survival in chronic heart failure patients with and without iron deficiency (ID)

Copyright permission obtained from Jankowska et al, 2010. Available here. By permission of Oxford University Press on behalf of the European Society of Cardiology.