P15 | Heart failure with reduced ejection fraction (HFrEF) and iron deficiency

V. Bernardis, M. Balbi | SOC Medicina Interna Ospedale San Vito al Tagliamento (PN), Italy

Premises: Importance of iron deficiency in HFrEF.
Materials and Methods: Data review regarding a population of 71 patients admitted between January and August 2023. 42 men and 29 women, average age 62 years. Admission Diagnosis: Heart failure NYHA class II-IV; HFrEF 50 (70%), dyspnea 97%, asthenia 81.6%. All on optimized therapy and with multiple comorbidities; CKD stages II-IV according to KDIGO with a mean eGFR of 35 ml/min; Underweight 15.5%, anemia 14%.
Results: Admission Hb between 9 g/dL and 14.9 g/dL, average 11.2 g/dL; serum iron levels between 8 μg/dL and 190 μg/dL, with an average of 35 μg/dL. Ferritin between 18 μg/L and 650 μg/L, with a median of 149 μg/L; ferritin <100 μg/l in 28 patients (39.4%). TSAT between 2.2% and 67.6%, average of 31.8%; TSAT decreased by 20% in 50 patients with HFrEF, which is 84.5% of cases. Symptoms at admission and reassessment at discharge: Dyspnea was present in 69 out of 71 cases at admission (97%) and in 6 out of 71 at discharge (8.4%). Asthenia was present in 58 out of 71 patients at admission (81.6%) and in 8 out of 71 patients at discharge (11%). A total of 49 patients (69%) were treated with an infusion of ferric carboxymaltose (1000 mg + 500 mg IV before discharge). Subsequent hospitalizations during the observation period were 4 (5.6%). On average, at discharge, Hb was found to have increased by at least 0.8 g/dL in treated patients.
Conclusions: The martial deficiency is confirmed as an essential factor to be evaluated and treated in this category of patients, regardless of the initial Hb value. The genesis is often multifactorial and plausible. Correction should be considered an additional therapeutic target beyond the use of ACE inhibitors/ARBs, ARNIs, MRAs, and SGLT2 inhibitors, as also indicated by recent guidelines.