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Heart failure & cardiomyopathiesCohort study

Iron Deficiency Definitions in Heart Failure Across Ejection Fraction Phenotypes

JACC Heart FailPublished

  • Registry-based cohort study
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Authors' conclusion

Irrespective of definition, ID was highly prevalent (highest in HFpEF) and independently associated with worse symptoms or HR-QoL. ID defined as TSAT <20% showed the strongest associations with outcomes, including mortality and HF or cardiovascular/noncardiovascular hospitalizations

Study context

Population
Patients in the Swedish Heart Failure (HF) Registry, 2017–2023
Participants
20,673 patients
Exposure
Four iron deficiency (ID) definitions across heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF)
Outcome
ID prevalence by definition and HF phenotype

Main finding

As reported in the abstract

ID prevalence (overall; HFrEF / HFmrEF / HFpEF)

ID prevalence (overall; HFrEF / HFmrEF / HFpEF)

HFrEF

HFmrEF

HFpEF

Observational data: associations, not effects.

Further findings

Symptoms and health-related quality of life (HR-QoL)

All definitions independently associated with worse symptoms; all except ferritin <100 μg/L with worse HR-QoL

CV or all-cause death, HF or all-cause/CV/non-CV hospitalizations

Transferrin saturation (TSAT) <20% and IRONMAN ID independently associated with higher risk of all outcomes
Guideline ID associated only with outcomes containing HF hospitalizations or total all-cause hospitalizations
Ferritin <100 μg/L associated with no outcome
TSAT <20% showed the greatest prognostic associations and discrimination

Outcomes containing HF hospitalization, by phenotype (subgroup)

TSAT <20% and IRONMAN ID had stronger associations in HFpEF
P for interaction < 0.05

Original publication

Iron Deficiency Definitions in Heart Failure Across Ejection Fraction Phenotypes. JACC Heart Fail. Published 3 October 2025. doi:10.1016/j.jchf.2025.102662
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Summarised from the published abstract; every number is checked against it