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Anemia, Iron Deficiency, and Heart Failure: What Clinicians Need to Know

Anemia, Iron Deficiency, and Heart Failure: What Clinicians Need to Know

Anemia and iron deficiency are common and important comorbid conditions in patients with heart failure (HF). These conditions are mediators of poor clinical status and outcomes. Thus, it is important for clinicians to understand both anemia and iron deficiency in the setting of HF.

Anemia can be present whether a patient has HF with reduced or preserved ejection fraction. It is present in about 30% of stable patients with HF and about 50% of patients hospitalized with HF. Patients with HF who have anemia tend to have more severe HF with poorer functional status, lower exercise capacity, worse health-related quality of life, more edema, greater diuretic requirement, and higher neurohormonal and pro-inflammatory cytokine activation than patients with HF who are nonanemic.

The pathogenesis of anemia in HF is multifactorial and has multiple interrelated mechanisms—one of which is neurohormonal activation. The main triggers of anemia in HF include functional or absolute iron deficiency, erythropoietin synthesis and response, and adverse events from various medications.

Iron deficiency is the most common contributing factor to anemia in HF. Iron is an important element in the body because of its role in maintaining the oxygen-carrying capacity of the blood, and is independently vital for oxygen transport, delivery, and utilization. At a cellular level, it is the key component of hemoglobin, myoglobin, and various enzymes that play a role in many important cellular metabolisms and activities. Iron also plays an important role in homeostasis and function of the myocytes, skeletal muscles, and neurologic and immune systems.

Iron deficiency in HF can be caused by a number of factors, including:

  • Poor intake, leading to malnutrition
  • Decreased absorption, due to GI edema or proton pump inhibitor use
  • Blood loss in the GI tract, usually due to antiplatelet or anticoagulant use
  • A chronic inflammatory state

In my next post, I'll discuss diagnosis and management strategies for anemia and iron deficiency in patients with HF.

  • Anand IS, Gupta P. Anemia and iron deficiency in heart failure: Current concepts and emerging therapies. Circulation. 2018;138:80–98.
  • Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Heart Failure. 2020;7:2007–2011.

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Filed under: Cardiometabolic

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