Table 3

Prevalence and outcomes of iron deficiency (summary of findings table)

StudySample size (HFpEF)% womenEjection fraction cut-off for HFpEFAverage age (years)Prevalence of iron deficiencyOutcome measuresOutcome
Araujo, 20152911769.8≥50%74.95±11.831.4%Nil (prevalence only)NA
Barandiaran, 20174011567.8≥50%50%Nil (prevalence only)NA
Bekfani, 201541233≥50%71±956%46.8%9.2%Peak VO2
Exercise time
EQ-5D questionnaire
Ferritin positively correlated with peak VO2, r=0.28, p=0.03
Exercise time negatively correlated with ferritin r=0.31, p=0.01
416±125 m IR, 367±138 m ID, p=0.05
Ferritin correlated positively with distance walked r=0.24, p=0.01
19062±4704 IR, 16373±5304 ID, p<0.05
Borut Jug, 201625220Not describedDeath or hospitalisation (composite)OR 1.88 (0.917–3.861), p=0.085 for iron-deficient patients
Adjusted for age, gender, NYHA class, ischaemic aetiology, natriuretic peptides, renal function, anaemia
Carmo, 20144447Not described78.9±9.272.3%Nil (prevalence only)NA
Fitzsimons*, 2015/201626 2728045%≥50%73.864%23%41%DeathHR 0.98 (0.53–1.81), p=0.95 for iron-deficient patients
Kasner, 2013192642%Not described55±8.558%35%23%NT-proBNP levels (pg/mL)
VO2 (mL/min/kg)
Exercise performance (W)
NT-proBNP 192±199 ID vs 169±109, p=0.095
17±1.5 ID vs 18±3 IR, p=0.93
102±25 ID vs 121±50 IR, p=0.49
Analyses were not adjusted but patients had similar baseline characteristics
Lainscak, 20154220742%≥50%71±1256%Nil (prevalence only in HFpEF)NA
Martens, 20172072≥50%64%VO2 (mL/min/kg)
All-cause mortality and hospitalisation
16±5 IR, 9±2 ID, p<0.001
Significantly higher in ID vs IR, p=0.001, adjusted for age, gender, implantable cardioverter defibrillator use, CRT use, ischaemic aetiology, medication use and baseline LVEF
Nieto Sandoval, 20172813965.3%≥50%79.8±867%19%48%DeathHigher ferritin associated with increased mortality in HFpEF (statistics not quoted)
Nunez, 2016224055%≥50%74±5.570%VO2Log VO2 correlated with TSAT (r=0.46, p=0.003) and ferritin (r=0.30, p=0.048) in HFpEF
Adjusted for gender, HR, NT-proBNP, eGFR, E/e′, Hb, TAPSE
Orynchak, 2014237965%≥50%53±8NYHA classNYHA class II/III associated with lower serum iron, ferritin and transferrin regardless of anaemia status
Yeo, 201443154≥50%61%Nil (prevalence only for HFpEF)NA
Yeo, 2014†24148≥50%60.1%MLHFQ
NYHA functional class
Patients with FID had worse MLHFQ compared with IR (28 vs 36, p<0.05)
Patients with FID had no difference in NYHA class compared with IR (1.85 vs 2, p=0.16)
  • *Fitzsimons et al had two papers reporting on the same cohort, therefore information on this cohort was gathered from the two publications and reported as the same population in our summary of findings table.

  • †Yeo et al did not use a standard definition of iron deficiency: they defined iron deficiency as transferrin saturation <20%, without any criteria for ferritin.

  • CRT, cardiac resynchronisation therapy; FID, functional iron deficiency; HFpEF, heart failure with preserved ejection fraction; ID, iron deficient; IR, iron replete; LVEF, left ventricular ejection fraction; MLHFQ, Minnesota Living with Heart Failure Questionnaire; 6MWT, 6 min walk test; NA, not available; NYHA, New York Heart Association; TAPSE, tricuspid annular plane systolic excursion; TSAT, transferrin saturation.