Heart failure & cardiomyopathies
Iron deficiency definitions and their clinical and prognostic associations across the spectrum of left ventricular ejection fraction in heart failure
Authors' conclusion
Iron deficiency is common and clinically relevant across the HF spectrum, irrespective of definition, and is associated with impaired quality of life and adverse outcomes in patients with LVEF <50%. In HFpEF, however, the prognostic impact of ID appears less pronounced and may depend on the definition applied
Study context
- Population
- Heart failure (HF) patients with known left ventricular ejection fraction (LVEF) and iron parameters (HFrEF, HFmrEF, HFpEF)
- Participants
- 3,642 patients
- Comparison
- Iron deficiency (ID) vs no ID across LVEF categories, by three ID definitions
Methodological detailspooled index and validation cohorts
- Pooled index and validation cohorts
Primary result
As reported in the abstract
Prevalence of ID
- Prevalence of ID ranged from 57% to 75% depending on definition and LVEF, highest in HFpEF and very low LVEF
- More than half met all three definitions; nearly one-third classified discordantly
Further findings
Quality of life and physical limitations
- ID associated with lower quality of life and greater physical limitations across all definitions and LVEF categories
- P < 0.01
Independent associates of ID
- Female sex, higher heart rate, proton pump inhibitor use, anaemia, hypoalbuminemia, worse renal function, fluid retention
CV and non-CV death, all-cause mortality, HF hospitalizations and composite (LVEF <50%)
- ID associated with increased risk across all definitions
- P < 0.05
Outcomes in HFpEF
- No definition showed consistent prognostic significance
- Interaction with LVEF group for IDTSAT and IDESC P_interaction <.05
Original publication
Iron deficiency definitions and their clinical and prognostic associations across the spectrum of left ventricular ejection fraction in heart failure. Eur J Heart Fail. Published 2 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it