Prognostic impact of iron deficiency in patients hospitalised with acute decompensated heart failure with reduced ejection fraction and chronic kidney disease
V Dimitrova, K Dyankov, K K KaramfiloffAbstract
Background
Iron deficiency is a frequent comorbidity in patients with heart failure with reduced ejection fraction and is associated with impaired functional capacity and adverse outcomes. Data on the prognostic impact of iron deficiency in hospitalised patients with concomitant chronic kidney disease remain limited.
Purpose
To evaluate the prevalence of iron deficiency and its association with in-hospital outcomes in patients admitted for acute decompensated chronic heart failure with reduced ejection fraction and moderate chronic kidney disease.
Methods
This retrospective real-world cohort study included 185 consecutive patients hospitalised for acute decompensated chronic heart failure with reduced ejection fraction between 2024 and 2025. Iron status was assessed in all patients using serum iron, total iron-binding capacity and ferritin. Iron deficiency was defined according to current guideline criteria. All patients had concomitant chronic kidney disease stage 3A or 3B. The primary outcome was in-hospital all-cause mortality.
Results
The study population included 115 women and 70 men. Iron deficiency was present in 127 patients (68.6%), with a predominance among women. Overall in-hospital mortality was 15.7% (29 deaths). Patients with iron deficiency showed a higher burden of comorbidity and worse in-hospital outcomes compared with patients without iron deficiency.
Conclusions
Iron deficiency is highly prevalent among patients hospitalised with acute decompensated heart failure with reduced ejection fraction and moderate chronic kidney disease, particularly in women. Its presence is associated with unfavourable in-hospital outcomes, highlighting the importance of systematic assessment of iron status in this high-risk population.