Iron deficiency and link to heart failure

Iron deficiency (ID) is the most common nutritional deficiency, affecting more than two billion people worldwide. India is no exception, with more than one-third of the population affected by this condition.

Moreover, people with chronic conditions like cancer, chronic kidney disease (CKD), heart failure (HF), diabetes etc. are also affected by iron deficiency. This is known as Anaemia of Chronic Diseases (ACDs). ACDs is the second most common anaemia, after iron deficiency anaemia.

Heart failure is a progressive disease, in which the heart muscle weakens and becomes stiff overtime, which reduces its ability to pump properly. This reduces the amount of oxygen and nutrients circulated to vital organs of the body.

Iron deficiency in heart failure is a progressive condition wherein the RBCs, apart from becoming fewer in number, get smaller in size too, causing anaemia which leads to an enlarged heart.

As a result, the heart must pump more blood to compensate for the lack of oxygen in the blood. This results in the heart working harder which isn’t a good sign for heart failure patients.

According to a study conducted to analyse iron deficiency in heart failure, three out of every four heart failure patients have iron deficiency.

In my clinical practice, I see about 20-25 new heart failure patients every month with most of them showing symptoms of iron deficiency. The major problem is awareness among these patients and effective counselling can help them understand the condition better and lead them to the correct mode of treatment.

Effects on heart failure

Iron deficiency can have a range of effects in the management and treatment care for heart failure. It can be caused with or without anaemia and can affect management of heart failure in the following ways:

Symptoms flare up: Symptoms flare up is the first and common sign of iron deficiency in heart failure. Despite medications, symptoms like shortness of breath, constant tiredness and fatigue, swelling in legs, ankles and abdomen etc. flare up in heart failure patients. In some severe cases, we have also seen worsening of the condition or refractory treatment despite proper line of medication. This can only be managed post correction of iron deficiency. Hence, iron levels need to be monitored carefully.

Recurring hospitalisation: Heart failure is a chronic condition where we see recurring hospitalisation if the condition isn’t managed properly. In cases of heart failure with iron deficiency, the hospitalisation rates increase owing to refractory treatment.

If a heart failure patient has a haemoglobin count of 9-10 RBCs, it is classified as iron deficiency in heart failure. The count has to be brought up to 13-14 to correct the condition. Recurring hospitalisations are significantly reduced post correction of iron deficiency in HF patients.

Risk of other co-morbidities: If a heart failure patient has iron deficiency, he is also at a risk of other co-morbid conditions like renal dysfunction. This can lead to treatment difficulty in management of both the conditions. Hence, iron level management is an integral part of heart failure treatment.

Therefore, it is essential for all heart failure patients to seek medical advice as soon as they experiencing any such symptoms despite ongoing treatment and get their iron levels checked.

Treatment options

There are various ways through which iron deficiency in heart failure can be managed and treated effectively. These include, Intravenous (IV) Iron, Oral Iron, Intramuscular (IM) Iron. As a cardiologist, I believe timely intervention leads to effective recovery and quality of life.

For this purpose IV Iron has shown significantly better results in heart failure patients. IV iron takes half an hour to get absorbed in the body and shows outcomes without any adverse reactions. Patients usually 1-2 doses of IV Iron which gives them a jumpstart to iron deficiency management which can later be managed with Oral Iron if required.

In the case of end-stage heart failure patients, IV Iron is preferred as the absorption rate is better than oral iron and the patients can recover better.

Overall, iron deficiency is an integral part of heart failure management and timely intervention can ensure faster recovery and a better quality of life.

(The writer is cardiologist & interventional cardiologist, Sakra World Hospital, Bengaluru)