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Original research
Iron deficiency in 78 805 people admitted with heart failure across England: a retrospective cohort study
  1. James M Beattie1,
  2. Rani Khatib2,3,
  3. Ceri J Phillips4 and
  4. Simon G Williams5
  1. 1Cicely Saunders Institute, King's College London, London, UK
  2. 2Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  3. 3Departments of Cardiology and Medicines Management, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4College of Human and Health Sciences, Swansea University, Swansea, West Glamorgan, UK
  5. 5North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Manchester, UK
  1. Correspondence to Dr James M Beattie; JMBeattie{at}


Objectives Iron deficiency (ID), with or without anaemia (IDA), is an important comorbidity in people with chronic heart failure (HF), but the prevalence and significance in those admitted with HF is uncertain. We assessed the prevalence of ID or IDA in adults (age ≥21 years) hospitalised with a primary diagnosis of HF, and examined key metrics associated with these secondary diagnoses.

Methods A retrospective cohort study of Hospital Episode Statistics describing all adults admitted to National Health Service (NHS) hospitals across England from April 2015 through March 2016 with primary diagnostic discharge coding as HF, with or without subsidiary coding for ID/IDA.

Results 78 805 adults were admitted to 177 NHS hospitals with primary coding as HF: 26 530 (33.7%) with secondary coding for ID/IDA, and 52 275 (66.3%) without. Proportionately more patients coded ID/IDA were admitted as emergencies (94.8% vs 87.6%; p<0.0001). Tending to be older and female, they required a longer length of stay (15.8 vs 12.2 days; p<0.0001), with higher per capita costs (£3623 vs £2918; p<0.0001), the cumulative excess expenditure being £21.5 million. HF-related (8.2% vs 5.2%; p<0.0001) and all-cause readmission rates (25.8% vs 17.7%; p<0.05) at ≤30 days were greater in those with ID/IDA against those without, and they manifested a small but statistically significant increased inpatient mortality (13.5% v 12.9%; p=0.009).

Conclusions For adults admitted to hospitals in England, principally with acute HF, ID/IDA are significant comorbidities and associated with adverse outcomes, both for affected individuals, and the health economy.

  • acute heart failure
  • iron deficiency
  • anaemia
  • hospital episode statistics
  • outcomes

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  • Contributors All authors (JMB, RK, CJP, SGW) were involved in the conception and design of the study, and interpretation of the results. All authors had access to all of the study data and can take responsibility for data integrity and the accuracy of analyses. CJP conducted the statistical analysis. JMB undertook primary drafting of the paper and all authors contributed to significant redrafting. JMB is the guarantor of the paper.

  • Funding Vifor Pharma UK Ltd funded unrestricted access to the HES data through Harvey Walsh Ltd.

  • Competing interests All authors have previously received consultancy fees from Vifor. JMB has also received meeting support and honoraria from Vifor. RK has received additional fees and educational grants from Novartis. All authors declare no conflict of interest in terms of this study and have completed the ICMJE uniform disclosure form at

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no additional data relevant to this paper.

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