Today, 26 November, is Iron Deficiency Day. Iron is essential for keeping our bodies and brains healthy. It brings oxygen to our blood cells, helps convert food into energy and enables us to maintain a normal immune system. Too little or too much iron has detrimental effects on the body and can lead to arrhythmia and blood pressure anomalies. In fact, chronic heart failure patients are more prone to iron deficiency.
Read our interview with Prof Fausto Pinto, WHF President, on the occasion of Iron Deficiency Day.
WHF: How common is iron deficiency in heart failure patients?
FP: Iron deficiency is common but often overlooked, especially in people with chronic conditions. It’s no exception for heart failure (HF) patients. About one in two heart failure patients are iron-deficient. For patients, symptoms of iron deficiency or anaemia, such as fatigue, may be difficult to distinguish from symptoms of heart failure.
WHF: How does iron deficiency impact heart failure patients?
FP: Heart failure patients who are iron-deficient typically have their functional capacity reduced, a higher risk of hospitalisation, increased symptoms, and a poorer quality of life. Therefore, it is very important to correct iron deficiency, to avoid patients becoming anaemic, as the signs and symptoms of heart failure will be exacerbated by iron deficiency.
WHF: The updated 2021 European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure have recently been published. Updates to the guidelines specific to the management of anaemia and iron deficiency say that it is recommended that all patients with heart failure are periodically be screened for anaemia and iron deficiency with a full blood count, serum ferritin concentration and transferrin saturation [TSAT]. What is important about this recommendation?
FP: Of course, patients need to be screened first, so we can then establish a diagnosis. Not all heart failure patients are iron-deficient or anaemic. What is important is to not only measure serum ferritin concentration, but also transferrin saturation. And hemoglobin is not the correct marker to identify iron deficiency. It is also important to screen patients periodically because the diagnosis can vary over time.
WHF: What about the other update regarding recommendations for diagnostic tests in all patients with suspected chronic HF in relation to iron deficiency? Why is it important and what are the benefits of screening patients that are suspected of having chronic HF?
FP: Iron deficiency is present in one-third of the world’s population. However, heart failure patients are disproportionately affected. As mentioned above, up to 50% of people living with chronic heart failure are iron-deficient. Unfortunately, it is a strong independent predictor of heart failure outcomes. Iron deficiency must not be neglected.
WHF: What do you hope the Iron Deficiency Awareness Day (26 November) and the Iron Deficiency Diagnosis month (November) can bring to the cardiovascular community?
FP: As much as 50% of patients with heart failure are found to be iron-deficient so I’d like to tell all my colleagues: screen your heart failure patients for iron deficiency as an easy, worthwhile step to greatly improving their quality of life. At the same time, I hope that more trainings will be given to healthcare providers, and that such awareness days will encourage scientific societies to advocate for accessible and affordable diagnosis tests everywhere.
Learn more about iron deficiency in heart failure here.
 McDonagh TA. et al. 2021; doi: 10.1093/eurheartj/ehab368
 The cut-off values for serum ferritin concentration and TSAT to determine iron deficiency are: Serum ferritin of <100 μg/L OR Serum ferritin of 100–299 μg/L with transferrin saturation (TSAT) <20%.