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Iron Deficiency Impacts Health Related Quality of Life

In patients with CHF, ID but not anemia was associated with reduced HRQoL (health related quality of life), mostly due to physical factors….

Health-related quality of life (HRQoL) is impaired in chronic heart failure (CHF), resulting in considerable impact on patients’ daily activities. Recent evidence suggests that iron deficiency (ID) in CHF patients may be associated with impaired exercise capacity, more severe disease (higher NYHA class), and poorer outcomes, although this latter observation remains controversial. ID is also associated with fatigue and impaired exercise capacity in otherwise healthy populations. In this study, Comín-Colet et al evaluated the influence of ID on HRQoL in CHF and explored its influence according to anemia status.

The authors undertook a post-hoc analysis of a cohort of CHF patients in a single-center study evaluating cognitive function. For inclusion in the study, patients had to be in a stable condition and diagnosed with CHF with either reduced or preserved (≥45%) EF, according to the European Society of Cardiology diagnostic criteria. A total of 552 CHF patients were eligible for inclusion, with an average age of 72 years and 40% in NYHA class III or IV. At recruitment, patients provided baseline information and completed the Minnesota Living with Heart Failure questionnaire (MLHFQ) for HRQoL (higher scores reflect worse HRQoL). The MLHFQ is a self-administered questionnaire consisting of 21 individual items. In addition, it provides an overall measure of health [overall summary score (OSS)] and summary scores of the physical and emotional dimensions of health, based on eight and five items, respectively. At baseline, blood samples were taken for serological evaluation. ID was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. Anemia was defined as hemoglobin ≤12 g/dL.

The MLHFQ overall summary scores were 41.0 ± 24.7 among those with ID, vs. 34.4 ± 26.4 for non-ID patients (P = 0.003), indicating worse HRQoL. When adjusted for other factors associated with HRQoL, ID was significantly associated with worse MLHFQ overall summary (P = 0.008) and physical dimension scores (P = 0.002), whereas anemia was not (both P > 0.05). Based on these results the authors concluded that CHF patients with ID suffer impaired HRQoL and that the effects are not due to the role of iron in erythropoiesis. In patients with ID, anemia itself had no effect on HRQoL, though reduced Hb levels could be associated with increased levels of iron depletion. In the context of CHF, there is accumulating evidence that ID may contribute to myocardial alterations, to fatigue and reduced exercise capacity, and to increased risk of mortality.

In clinical trials, i.v. iron treatment can improve CHF symptoms, increase exercise capacity, and improve HRQoL in patients with ID with or without anemia.

Practice Pearls:

  • CHF patients with iron deficiency suffer impaired HRQoL.
  • In patients with iron deficiency, anemia itself had no effect on HRQoL.
  • Iron deficiency in CHF patients may be associated with impaired exercise capacity, more severe disease (higher NYHA class), and poorer outcomes

European Journal of Heart Failure, October 2013