Iron deficiency in heart failure patients: the French CARENFER prospective study

Cohen‐Solal, Alain; Philip, J.; Picard, François; Delarche, Nicolas; Taldir, Guillaume; Gzara, Heger; Korichi, Anissa; Trochu, Jean‐Noël; Cacoub, P.

doi:10.1002/ehf2.13850

Cited by 28 publications

(27 citation statements)

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“…The CARENFER studies were conducted in France between May 2019 and June 2021. The four of them consisted of a cross-sectional, multicenter, and nationwide study carried out to determine the prevalence of ID in patients with cancer [ 17 ], HF [ 18 ], CKD [ 19 ], and IBD [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

“…Even if anemia is often the final consequence of ID [ 5 ], several studies showed that independently of the presence of anemia, ID appeared as a risk factor of mortality in patients with chronic HF (CHF) [ 11 , 16 ] and CKD [ 12 , 13 ]. Recently, we showed that the prevalence of ID is high in all patients with chronic inflammatory disease, independently of the presence of factors known to influence the occurrence of ID [ 17 , 18 , 19 , 20 ]. Therefore, ID should be considered an independent therapeutic objective in patients with chronic inflammatory conditions, that is, a comorbidity that should be systematically detected and treated if identified [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…In this article, we assessed the prevalence of ID in patients with chronic inflammatory diseases using a common definition for the diagnosis of ID, whatever the underlying chronic disease. For that purpose, we used data collected during the CARENFER studies, which were nationwide cross-sectional surveys carried out in France in patients with cancer [ 17 ], HF [ 18 ], CKD [ 19 ], and IBD [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases

et al. 2022

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Iron deficiency (ID) in patients with chronic inflammatory diseases is frequent. However, under-diagnosis is also frequent due to the heterogeneity between guidelines from different medical societies. We applied a common definition for the diagnosis of ID to a large panel of patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD), where ID was defined as serum ferritin concentration <100 μg/L and/or a transferrin saturation (TSAT) index <20%. Prevalence estimates using this common definition were compared with that obtained with officially accepted definitions (ESMO 2018, ESC 2016, ECCO 2015, and ERBP 2013). For that purpose, we used data collected during the French CARENFER studies, which included 1232, 1733, 1090, and 1245 patients with cancer, HF, IBD, and CKD, respectively. When applying the common definition, ID prevalence increased to 58.1% (vs. 57.9%), 62.8% (49.6%), and 61.2% (23.7%) in cancer, HF, and IBD patients, respectively. Both prevalence estimates were similar (47.1%) in CKD patients. Based on our results, we recommend combining both ferritin concentration and TSAT index to define ID in patients with chronic inflammatory diseases. In those patients, adopting this common definition of ID should contribute to a better screening for ID, whatever the condition.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases

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“…The French nationwide prospective CARENFER survey performed during 2019-2020 in hospitalized patients reported comparable high prevalence rates-57.9% (n = 1221) in patients with solid tumors, 49.6% (n = 1661) in CHF, 47.1% (n = 1211) in nondialyzed CKD, and 23.7% (n = 1090) in IBD [10][11][12][13].…”

Section: Iron Deficiency Is Frequent In Chronic Conditionsmentioning

confidence: 99%

Iron deficiency screening is a key issue in chronic inflammatory diseases: A call to action

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Iron deficiency is frequent in patients with chronic inflammatory conditions (e.g., chronic heart failure, chronic kidney disease, cancers, and bowel inflammatory diseases). Indeed, high concentrations of inflammatory cytokines increase hepcidin concentrations that lead to the sequestration of iron in cells of the reticuloendothelial system (functional iron deficiency). Iron parameters are often assessed only in the context of anemia, but iron deficiency, even without anemia, is present in about half of patients with inflammatory conditions. Iron deficiency worsens underlying chronic diseases and is an independent factor of morbidity and mortality. In daily practice, the most effective biomarkers of iron status are serum ferritin, which reflects iron storage, and transferrin saturation, which reflects the transport of iron. Serum ferritin is increased in an inflammatory context, and there is still no consensus on the threshold to be used in chronic inflammatory conditions. Nevertheless, recent recommendations of international guidelines agreed to define iron deficiency by serum ferritin <100 µg/L and/or transferrin saturation <20%. Iron parameters remain, however, insufficiently assessed in patients with chronic inflammatory conditions. Indeed, clinical symptoms of iron deficiency, such as fatigue, are not specific and often confused with those of the primary disease. Iron repletion, preferably by the intravenous route to bypass tissue sequestration, improves clinical signs and quality of life. Because of the negative impact of iron deficiency on chronic inflammatory diseases and the efficacy of intravenous iron repletion, screening of iron parameters should be part of the routine examination of all patients with chronic inflammatory diseases.

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“…Iron deficiency is one of the most commonly seen comorbid conditions in patients who have HF, with studies reporting that approximately 40−70% of patients with CHF have iron deficiency [ 5 , 7 , 32 , 33 , 34 , 35 , 36 ], regardless of their ejection fraction [ 9 ]. Iron deficiency also has a prevalence of up to 80% in patients with acute HF (AHF) [ 10 , 37 ].…”

Section: Why Is Diagnosing and Treating Iron Deficiency In Patients W...mentioning

confidence: 99%

Practical Guidance for Diagnosing and Treating Iron Deficiency in Patients with Heart Failure: Why, Who and How?

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Doehner

Manito

et al. 2022

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Iron deficiency (ID) is a comorbid condition frequently seen in patients with heart failure (HF). Iron has an important role in the transport of oxygen, and is also essential for skeletal and cardiac muscle, which depend on iron for oxygen storage and cellular energy production. Thus, ID per se, even without anaemia, can be harmful. In patients with HF, ID is associated with a poorer quality of life (QoL) and exercise capacity, and a higher risk of hospitalisations and mortality, even in the absence of anaemia. Despite its negative clinical consequences, ID remains under-recognised. However, it is easily diagnosed and managed, and the recently revised 2021 European Society of Cardiology (ESC) guidelines on HF provide specific recommendations for its diagnosis and treatment. Prospective randomised controlled trials in patients with symptomatic HF with reduced ejection fraction (HFrEF) show that correction of ID using intravenous iron (principally ferric carboxymaltose [FCM]) provides improvements in symptoms of HF, exercise capacity and QoL, and a recent trial demonstrated that FCM therapy following hospitalisation due to acute decompensated HF reduced the risk of subsequent HF hospitalisations. This review provides a summary of the epidemiology and pathophysiology of ID in HFrEF, and practical guidance on screening, diagnosing, and treating ID.

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Iron deficiency in heart failure patients: the French CARENFER prospective study

Cited by 28 publications

References 35 publications

Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases

Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases

Iron deficiency screening is a key issue in chronic inflammatory diseases: A call to action

Practical Guidance for Diagnosing and Treating Iron Deficiency in Patients with Heart Failure: Why, Who and How?

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