Prevalence and Spectrum of Iron Deficiency in Heart Failure Patients in a Tertiary Cardiac Centre in Nepal

Abstract

Background: Iron deficiency (ID) is a major heart failure comorbidity associated with increased mortality, worse symptoms and a poorer quality of life, irrespective of anaemia. In Nepal, limited data are available to permit an estimation of the spectrum and prevalence of ID associated with heart failure, which the present study aimed to find. Methods: A single-centre, cross-sectional, observational study was conducted at a tertiary care hospital in Kathmandu, Nepal. Patients meeting validated clinical criteria of heart failure were included and assessed for their iron status. Absolute ID was defined as serum ferritin <100 μg/l and functional ID was defined as normal ferritin (100–300 μg/l), with low transferrin saturation <20%. Data were analysed using SPSS (version 23). A logistic regression model was used to calculate the OR, with p-values <0.05 and 95% CIs. Results: A total of 400 patients were studied. Anaemia was present in 244. ID was present in 314 (78.5%) patients, out of which absolute deficiency was present in 181 (57.6%) and functional deficiency was present in 133 (42.4%) patients. ID with anaemia was present in 222 patients. Female sex (OR 1.93; 95% CI [1.18–3.18]), New York Heart Association class III/IV (OR 2.46; 95% CI [1.48–4.07]), age >65 years (OR 1.97; 95% CI [1.21–3.21]) and anaemia (OR 7.01; 95% CI [4.08–12.06]) were significantly associated with ID. ID without anaemia was present in 29% of patients. Conclusion: The present study showed a high prevalence of ID in heart failure patients, which was significantly associated with older age, female sex and higher New York Heart Association class. It also showed that a significant number of patients who were non-anaemic had ID. Therefore, iron profiling and treatment should be a part of the routine assessment of patients with heart failure.