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Tsangaris A, Ambrosy AP, Tschida M, Alexy T. Settling the IRONy of Anemia in Heart Failure: Current Evidence and Future Directions. J Card Fail 2024; 30:691-693. [PMID: 38401670 DOI: 10.1016/j.cardfail.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Affiliation(s)
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, MN
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Yuan C, He L, Du X, Jiang C, Xia S, Zhao X, Li S, Sang C, Long D, Dong J, Ma C. Impact of age on characteristics, performance measures and outcomes of inpatients for heart failure in Beijing, China. ESC Heart Fail 2023; 10:2990-2997. [PMID: 37528635 PMCID: PMC10567638 DOI: 10.1002/ehf2.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023] Open
Abstract
AIMS This study aims to provide representative information on heart failure (HF) patients in China, especially older adults aged ≥75 years. We aim to clarify the age-related discrepancies in performance measures and the modifying effect of age on the impact of HF patients' characteristics on clinical outcomes. METHODS AND RESULTS All HF patients admitted into five tertiary and four secondary hospitals of the Capital Medical University were divided into two groups according to age: 1419 (53.3%) were <75 years, and 1244 (46.7%) were ≥75 years. Older HF patients were more likely to be women, with higher left ventricular ejection fraction, with co-morbidities including chronic obstructive pulmonary disease/asthma, anaemia, chronic kidney disease, stroke/transient ischemic attack (TIA), atrial fibrillation/atrial flutter, hypertension, and coronary artery disease, while obesity, diabetes mellitus, hypercholesterolaemia and valvular heart disease were more prevalent among younger HF patients. Left ventricular ejection fraction assessment was performed in a similar proportion of patients in the younger and older groups (81.7% vs. 80.5%, P = 0.426), while B-type natriuretic peptide/N terminal pro brain natriuretic peptide was tested in a lower proportion in the younger group (84.8% vs. 89%, P = 0.001). At discharge, HF with reduced ejection fraction patients were less likely to receive beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, or combined beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers therapy in the older group (49.74% vs. 63.2%, P = 0.002; 52.9% vs. 64.7%, P = 0.006; and 28.57% vs. 45.5%, P < 0.001, respectively) but were equally likely to receive mineralocorticoid receptor antagonists in the two age groups (80.8% vs. 84.1%, P = 0.322). Older patients with HF had higher risk of in-hospital and 1 year mortality (2.7% vs. 1.3%, P = 0.011; 21.7% vs. 12.5%; P < 0.001, respectively). Higher body mass index was associated with better outcomes in both age groups. New York Heart Association functional class IV and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were independent predictors of 1 year mortality. The associations between patients' characteristics and risk of mortality were not modified by age. CONCLUSIONS HF patients aged ≥75 years had distinct clinical profiles, received worse in-hospital therapies and experienced higher in-hospital and 1 year mortality.
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Affiliation(s)
- Cong Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
- The Affiliated Changsha Hospital of Xiangya School of MedicineCentral South UniversityChangshaChina
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
- Heart Health Research CenterBeijingChina
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Shi‐Jun Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Song‐Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Cai‐Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - De‐Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Jian‐Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Chang‐Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
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Beavers CJ, Ambrosy AP, Butler J, Davidson BT, Gale SE, Piña IL, Mastoris I, Reza N, Mentz RJ, Lewis GD. Iron Deficiency in Heart Failure: A Scientific Statement from the Heart Failure Society of America. J Card Fail 2023; 29:1059-1077. [PMID: 37137386 DOI: 10.1016/j.cardfail.2023.03.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
Iron deficiency is present in approximately 50% of patients with symptomatic heart failure and is independently associated with worse functional capacity, lower quality of, life and increased mortality. The purpose of this document is to summarize current knowledge of how iron deficiency is defined in heart failure and its epidemiology and pathophysiology, as well as pharmacological considerations for repletion strategies. This document also summarizes the rapidly expanding array of clinical trial evidence informing when, how, and in whom to consider iron repletion.
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Affiliation(s)
- Craig J Beavers
- University of Kentucky College of Pharmacy, Lexington, Kentucky.
| | - Andrew P Ambrosy
- Kaiser Permanente Northern California - Division of Research (DOR), Oakland, CA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas; University of Mississippi, Jackson, Mississippi
| | - Beth T Davidson
- Centennial Heart Cardiovascular Consultants, Nashville, Tennessee
| | - Stormi E Gale
- Novant Health Matthews Medical Center, Matthews, North Carolina
| | - Ileana L Piña
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Nosheen Reza
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Mentz
- Duke University School of Medicine, Durham, North Carolina
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Safety and Efficacy of Intravenous Ferric Derisomaltose Compared to Iron Sucrose for Iron Deficiency Anemia in Patients with Chronic Kidney Disease With and Without Heart Failure. Am J Cardiol 2021; 152:138-145. [PMID: 34162484 DOI: 10.1016/j.amjcard.2021.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022]
Abstract
Ferric derisomaltose (FDI) is an intravenous (IV) high-dose iron formulation approved in the US for the treatment of iron deficiency anemia in adults who are intolerant of/have had an unsatisfactory response to oral iron, or who have non-dialysis-dependent chronic kidney disease (NDD-CKD). FERWON-NEPHRO was a randomized, open-label, multicenter clinical trial evaluating the safety and efficacy of a single infusion of FDI 1,000 mg versus up to 5 doses of iron sucrose (IS) 200 mg (recommended cumulative dose, 1,000 mg) over 8 weeks in patients with NDD-CKD and iron deficiency anemia. Of 1,525 patients included in the safety analysis, 244 (16%) had a history of heart failure (HF). Overall, the rate of serious or severe hypersensitivity reactions was low and did not differ between treatment groups. Cardiovascular adverse events (AEs) were reported for 9.4% of patients who had HF and 4.2% who did not. Time to first cardiovascular AE was longer following administration of FDI compared with IS (hazard ratio: 0.59 [95% CI: 0.37, 0.92]; p=0.0185), a difference that was similar in patients with or without HF (p=0.908 for interaction). Patients achieved a faster hematological response (assessed by changes in hemoglobin and ferritin concentrations, and increase in transferrin saturation) with FDI versus IS. In conclusion, in patients with NDD-CKD, a single infusion of FDI was safe, well tolerated, and was associated with fewer cardiovascular AEs and a faster hematological response, compared to multiple doses of IS. These effects were similar for patients with and without HF.
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Grau Amorós J, García García JÁ, Mira Escartí JA, Serrado Iglesias A, Moreno García MC, Manzano L, Quesada Simón MA, Dávila Ramos MF, Casado Cerrada J, González Franco Á, Montero-Pérez-Barquero M. Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study). Med Clin (Barc) 2021; 158:167-172. [PMID: 33962767 DOI: 10.1016/j.medcli.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. PATIENTS AND METHOD Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. RESULTS 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF. CONCLUSIONS Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.
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Affiliation(s)
| | | | | | | | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, España
| | | | | | | | - Álvaro González Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Palau P, Llàcer P, Domínguez E, Tormo JP, Zakarne R, Mollar A, Martínez A, Miñana G, Santas E, Almenar L, Fácila L, De La Espriella R, Núñez E, Manzano L, Bayés-Genís A, Núñez J. Iron deficiency and short-term adverse events in patients with decompensated heart failure. Clin Res Cardiol 2021; 110:1292-1298. [PMID: 33721056 DOI: 10.1007/s00392-021-01832-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology's (ESC) current definition of ID (ferritin < 100 μg/L or TSAT < 20% if ferritin is 100-299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF. METHODS We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24-72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint. RESULTS Participants' median (quartiles) age was 76 (68-82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction > 50%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900-8764), 14.1% (9.0-20.3), and 103 ug/L (54-202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p = 0.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99-1.00, p = 0.347). CONCLUSIONS Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | | | | | - Rim Zakarne
- FISABIO, Universitat Jaume I, Castellón, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Ana Martínez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Luis Almenar
- Servicio de Cardiología, Hospital La Fe. Universitat de València, Valencia, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Hospital General Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Rafael De La Espriella
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Luis Manzano
- Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias I Pujol, Badalona. Universitat Autònoma de Barcelona, Badalona, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain. .,CIBER Cardiovascular, Madrid, Spain.
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Ambrosy AP, Fitzpatrick JK, Tabada GH, Gurwitz JH, Artz A, Schrier SL, Rao SV, Reynolds K, Smith DH, Peterson PN, Fortmann SP, Sung SH, Cohen HJ, Go AS. A reduced transferrin saturation is independently associated with excess morbidity and mortality in older adults with heart failure and incident anemia. Int J Cardiol 2020; 309:95-99. [DOI: 10.1016/j.ijcard.2020.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
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Burton JK, Yates LC, Whyte L, Fitzsimons E, Stott DJ. New horizons in iron deficiency anaemia in older adults. Age Ageing 2020; 49:309-318. [PMID: 32103233 DOI: 10.1093/ageing/afz199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022] Open
Abstract
Iron deficiency anaemia (IDA) is common in older adults and associated with a range of adverse outcomes. Differentiating iron deficiency from other causes of anaemia is important to ensure appropriate investigations and treatment. It is possible to make the diagnosis reliably using simple blood tests. Clinical evaluation and assessment are required to help determine the underlying cause and to initiate appropriate investigations. IDA in men and post-menopausal females is most commonly due to occult gastrointestinal blood loss until proven otherwise, although there is a spectrum of underlying causative pathologies. Investigation decisions should take account of the wishes of the patient and their competing comorbidities, individualising the approach. Management involves supplementation using oral or intravenous (IV) iron then consideration of treatment of the underlying cause of deficiency. Future research areas are outlined including the role of Hepcidin and serum soluble transferrin receptor measurement, quantitative faecal immunochemical testing, alternative dosing regimens and the potential role of IV iron preparations.
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Affiliation(s)
- Jennifer Kirsty Burton
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Luke C Yates
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lindsay Whyte
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Edward Fitzsimons
- Department of Haematology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David J Stott
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Wee YH, Anpalahan M. The Role of Older Age in Normocytic Anaemia in Type 2 Diabetes Mellitus. Curr Aging Sci 2019; 12:76-83. [PMID: 31244445 DOI: 10.2174/1874609812666190627154316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older age has a significant association with anaemia. However, this has not been adequately investigated in the context of specific comorbidities such as Type 2 Diabetes Mellitus (T2DM). OBJECTIVES To investigate the role of age in Normocytic Anaemia (NCA) and the adverse outcomes of NCA in T2DM. METHODS Patients with NCA, either unexplained or related to Chronic Kidney Disease (CKD), were recruited from a diabetic clinic over six months. Anaemia was defined as a haemoglobin(Hb) < 130g/l for men and <120g/l for women. The relevant data were obtained by interviewing patients and review of medical records. Patients were followed for 12 months for pre-defined adverse outcomes. RESULTS Of the 354 patients assessed, 203 were included (mean age 63.12 ± 13.62 years, males 49.8%). The prevalence of NCA was 24% (49). Older age had a significant univariate association with NCA (p < 0.001) and this remained significant (adjusted Odds Ratio (OR) 1.24, 95% CI 1.16- 5.29) after adjusting for estimated Glomerular Filtration Rate (eGFR) < 60ml/min/1.73m2, albuminuria and other potential confounders. Adjusting for eGFR as a continuous variable also confirmed this significant association (OR1.15, 95% CI 1.10-7.01). In the subgroup of patients aged ≥ 75 years, only older age was significantly associated with NCA. The incidence of all-cause mortality and composite cardiovascular/cerebrovascular events was similar in the anaemic and nonanaemic groups. CONCLUSION NCA is common in T2DM and has a significant association with older age independent of CKD. The anaemia is mild in most patients and appears to have a benign course.
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Affiliation(s)
- Yen H Wee
- Department of Aged Care and Rehabilitation, General Medicine, Alfred Health, Melbourne, Australia.,Department of General Medicine, Eastern Health, Melbourne, Australia
| | - Mahesan Anpalahan
- Department of General Medicine, Eastern Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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