Impact of iron deficiency on congestion and postdischarge survival in patients recently hospitalised for decompensated heart failure: a multicentre, prospective, observational analysis of the FERIC-RO study.

Background: Iron deficiency (ID) is a highly prevalent comorbidity in patients with chronic and acute heart failure and is associated with worse clinical outcomes. We aimed to evaluate the prevalence and clinical characteristics of ID and its association with in-hospital congestion and postdischarge outcomes.

Methods: FiER deficit in Insuficienta Cardiaca in Romania was a prospective, multicentric study, enrolling 163 patients hospitalised for worsening chronic heart failure (WCHF) irrespective of left ventricular ejection fraction. ID was evaluated at discharge and defined as ferritin<100 ng/mL or ferritin 100-299 ng/mL with transferrin saturation<20%. Patients were classified based on ID status. In-hospital changes of clinical signs of congestion and natriuretic peptides (NT-proBNP) were reported and correlated with ID status. Additionally, survival analysis at 30 and 90 days was performed and compared between patients with ID+ and ID-.

Results: The prevalence of ID was 54.6% (N=89) among 163 eligible patients. Patients with ID+ had more clinical signs of congestion and advanced New York Heart Association functional class at discharge (classes III and IV 58.4% vs 31.1%; p 0.002). NT-proBNP values at admission were higher in ID+ (9288 pg/dL vs 4414 pg/dL, p<0.001), with lower NT-proBNP decrease during hospitalisation (-45.7% vs -63.3%, p 0.003). Additionally, there was no difference in ID prevalence between discharge and 30 days after (54.6% vs 51.3%, p 0.782). Postdischarge all-cause mortality did not differ between ID+ and ID- at 30 days (5.6%% vs 2.7%, p 0.361), but at 90 days, it was higher in ID+ group (30.9% ID+ vs 9.6% ID-, p 0.005).

Conclusions: Patients hospitalised for WCHF and ID had more residual congestion, higher absolute values and significantly lower in-hospital change of NT-proBNP. A significant difference in survival between the two ID groups emerged within 90 days of hospital discharge.