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Long-term effects of iron deficiency in patients with heart failure with or without anemia: the RAID-HF follow-up study

Harm Wienbergen, Otmar Pfister, Matthias Hochadel, Andreas Fach, Tina Backhaus, Oliver Bruder, Björn Andrew Remppis, Micha T. Maeder, Wolfgang Von Scheidt, Matthias Pauschinger, Jochen Senges, Rainer Hambrecht & RAID-HF (Registry Analysis Of Iron Deficiency-Heart Failure) Study Group

abstract

INTRODUCTION
Iron deficiency (ID) has been recognized as a relevant comorbidity in heart failure with reduced ejection fraction (HFrEF); however, study data have shown that diagnostic and therapeutic efforts on ID are primarily performed in patients with anemia.

METHODS
The RAID-HF registry investigated consecutive patients with ID and HFrEF in 11 heart centers in Germany and Switzerland. The present analysis focuses on 1-year follow-up data in patients with versus without anemia.

RESULTS
In 505 patients with HFrEF and ID and 418 patients with HFrEF without ID 1-year follow-up was performed. Patients with ID had a higher long-term mortality compared to those without ID (19.5% vs. 13.7%, p = 0.02) and reported a lower quality of life. Only a minority of patients with ID (9.3%) received iron supplementation during long-term course, just 4.7% intravenously. Anemia was associated with an elevated mortality whereas ID versus no ID did not predict mortality in anemic patients (log-rank p = 0.78). However, in patients without anemia ID versus no ID predicted mortality (log-rank p = 0.002). In the adjusted analysis a significant interaction remained, with ID being a significant predictor of 1-year mortality in patients without anemia (HR 2.15, 95% CI 1.12-3.78), but not in anemic patients (HR 0.99, 95% CI 0.65-1.49).

CONCLUSIONS
RAID-HF demonstrates the impact of ID on long-term mortality and quality of life in patients with HFrEF and reveals an underuse of iron supplementation in current clinical practice. Particularly in patients without anemia the diagnosis of ID is of clinical relevance to identify patients at higher mortality risk.
   
citation Wienbergen H, Pfister O, Hochadel M, Fach A, Backhaus T, Bruder O, Remppis B A, Maeder M T, Von Scheidt W, Pauschinger M, Senges J, Hambrecht R, RAID-HF (Registry Analysis Of Iron Deficiency-Heart Failure) Study Group . Long-term effects of iron deficiency in patients with heart failure with or without anemia: the RAID-HF follow-up study. Clin Res Cardiol 2018;.
   
type journal paper/review (English)
date of publishing 12-07-2018
journal title Clin Res Cardiol
ISSN electronic 1861-0692
PubMed 30003365
DOI 10.1007/s00392-018-1327-y