Iron Deficiency Common in Heart Failure Patients- A recent study published in Circulation has revealed that iron deficiency is a common issue among patients with heart failure and is linked to worse outcomes.
However, the researchers also discovered that dapagliflozin – a medication commonly used to treat diabetes – may help improve outcomes regardless of iron status at baseline.
The study, DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), explored the prevalence and consequences of iron deficiency among heart failure patients as well as its effect on markers of iron metabolism.
Iron deficiency was defined as either a ferritin level below 100 ng/mL or transferrin saturation below 20% with a ferritin level between 100-299 ng/mL.
Additional biomarkers of iron metabolism such as soluble transferrin receptor, erythropoietin and hepcidin were measured both at baseline and 12 months after randomization.
At baseline, of the 4,744 patients randomized in the DAPA-HF trial, 3,009 had ferritin and transferrin saturation measurements available; 1,314 (43.7%) were iron deficient. T
he study revealed that patients with iron deficiency experienced higher rates of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy or cardiovascular death than those without (16.6% per 100 person-years vs 10.4%, respectively).
However, the study also discovered that dapagliflozin increased iron use while improving outcomes regardless of baseline iron status. The effect was similar between iron-deficient and iron-replete patients for the primary outcome as well as cardiovascular death, heart failure hospitalization, and all-cause mortality rates.
Furthermore, transferrin saturation, ferritin, hepcidin were reduced with dapagliflozin treatment versus placebo while total iron binding capacity and soluble transferrin receptor were enhanced when taking dapagliflozin over placebo treatment.
The study’s authors conclude that iron deficiency is common in heart failure patients and linked to worse outcomes.
Dapagliflozin may help improve these patients’ outcomes regardless of their baseline iron status. These findings have important ramifications for treating heart failure patients with iron deficiency, and future research may explore its potential advantages in this population.
Source- Docherty KF, Welsh P, Verma S, De Boer RA, O’Meara E, Bengtsson O, Køber L, Kosiborod MN, Hammarstedt A, Langkilde AM, Lindholm D, Little DJ, Sjöstrand M, Martinez FA, Ponikowski P, Sabatine MS, Morrow DA, Schou M, Solomon SD, Sattar N, Jhund PS, McMurray JJV; DAPA-HF Investigators and Committees. Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF. Circulation. 2022 Sep 27;146(13):980-994. doi: 10.1161/CIRCULATIONAHA.122.060511. Epub 2022 Aug 16. PMID: 35971840; PMCID: PMC9508991.
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