{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:42:00Z","timestamp":1772851320822,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":469,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Iron deficiency (ID) is prevalent in chronic heart failure (HF) but lacks a consensus definition. This study evaluates the prevalence and the prognostic impact of ID using different criteria on all-cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new-onset chronic HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this nationwide registry-based cohort, we explored four definitions of ID: the current European Society of Cardiology (ESC) guidelines [ferritin &amp;lt;100 ng\/mL or ferritin 100\u2013299 ng\/mL and transferrin saturation (TSAT) &amp;lt;20%], ferritin level &amp;lt;100 ng\/mL, TSAT &amp;lt; 20% and serum iron \u226413 \u03bcmol\/L. Patients were identified through the Danish Heart Failure Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 9477 new-onset chronic HF patients registered in the Danish Heart Failure Registry from April 2003 to December 2019, we observed ID prevalence rates ranging from 35.8% to 64.3% depending on the ID definition used. Among patients with ID defined by iron \u226413 \u03bcmol\/L or TSAT &amp;lt; 20%, 26% and 15.5%, respectively, did not meet the ESC guidelines definition for ID. Conversely, 11% of patients meeting the ESC criteria exhibited serum iron &amp;gt;13 \u03bcmol\/L and TSAT &amp;gt; 20%. Regardless of anaemia status, ID defined by TSAT &amp;lt; 20% or serum iron \u226413 \u03bcmol\/L was associated with all-cause mortality [non-anaemic, hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.30\u20131.89 and HR: 1.47, 95% CI: 1.24\u20131.73; anaemic, HR: 1.22, 95% CI: 1.07\u20131.38 and HR: 1.25, 95% CI: 1.09\u20131.44, respectively] and cardiovascular mortality (non-anaemic, HR: 2.21, 95% CI: 1.59\u20133.06 and HR: 1.47, 95% CI: 1.12\u20131.95; anaemic, HR: 1.37, 95% CI: 1.11\u20131.69 and HR: 1.28, 95% CI: 1.02\u20131.61, respectively), as well as increased risk of first hospitalization for HF (non-anaemic, HR: 1.28, 95% CI: 1.09\u20131.1.50 and HR: 1.27, 95% CI: 1.10\u20131.46; anaemic, HR: 1.25, 95% CI: 1.08\u20131.44 and HR: 1.22, 95% CI: 1.05\u20131.42, respectively). ID defined by ESC guidelines was associated with all-cause and cardiovascular mortality only in non-anaemic patients (HR: 1.41, 95% CI: 1.18\u20131.1.70 and HR: 1.58, 95% CI: 1.18-2.12.). Furthermore, the ESC guideline definition was associated with increased risk of first hospitalization for HF, regardless of anaemia status (non-anaemic, HR: 1.26, 95% CI: 1.08\u20131.1.47; anaemic, HR: 1.34, 95% CI: 1.17\u20131.53).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ID, when defined by TSAT &amp;lt; 20% or serum iron \u226413 \u03bcmol\/L, is associated with increased risk of all-cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new-onset chronic HF, regardless of anaemia status. Conversely, ID defined as ESC guidelines is associated with all-cause and cardiovascular mortality only in non-anaemic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15149","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T19:55:18Z","timestamp":1730922918000},"page":"1346-1357","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prognostic Impact of Iron Deficiency in New-Onset Chronic Heart Failure: Danish Heart Failure Registry Insights"],"prefix":"10.1093","volume":"12","author":[{"given":"Abdullahi Ahmed","family":"Mohamed","sequence":"first","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M\u00f8lager","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milan","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Torp-Pedersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Nordsj\u00e6llands Hospital , Hiller\u00f8d ,","place":["Denmark"]},{"name":"Department of Public Health, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emil Loldrup","family":"Fosb\u00f8l","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tor","family":"Biering-S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen ,","place":["Denmark"]},{"name":"Department of Cardiology, Copenhagen University Hospital - Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Steno Diabetes Center Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten Lock","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam Elmegaard","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Nouhravesh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Duke Clinical Research Institute , Durham, North Carolina ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Anderrson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Center for Advanced Heart Disease, Section of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten","family":"Schou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunnar","family":"Gislason","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"2026021804003619400_ehf215149-bib-0001","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s00392-016-1073-y","article-title":"Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: the PrEP Registry","volume":"106","author":"von Haehling","year":"2017","journal-title":"Clin Res Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0002","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1186\/s12872-018-0942-x","article-title":"Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: insights from an observational cohort study","volume":"18","author":"Gonz\u00e1lez-Costello","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"key":"2026021804003619400_ehf215149-bib-0003","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.ahj.2013.01.017","article-title":"Iron deficiency in chronic heart failure: an international pooled analysis","volume":"165","author":"IjT","year":"2013","journal-title":"Am Heart J"},{"key":"2026021804003619400_ehf215149-bib-0004","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s00392-018-1344-x","article-title":"Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life","volume":"108","author":"Bekfani","year":"2019","journal-title":"Clin Res Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0005","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1080\/00015385.2017.1351239","article-title":"Impact of iron deficiency on exercise capacity and outcome in heart failure with reduced, mid-range and preserved ejection fraction","volume":"73","author":"Martens","year":"2018","journal-title":"Acta Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0006","doi-asserted-by":"publisher","first-page":"1844","DOI":"10.1002\/ejhf.2338","article-title":"Phenotyping heart failure patients for iron deficiency and use of intravenous iron therapy: data from the Swedish Heart Failure Registry","volume":"23","author":"Becher","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0007","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026021804003619400_ehf215149-bib-0008","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.jacc.2021.11.039","article-title":"Criteria for iron deficiency in patients with heart failure","volume":"79","author":"Masini","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0009","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1016\/j.cardfail.2023.03.025","article-title":"Iron deficiency in heart failure: a scientific statement from the Heart Failure Society of America","volume":"29","author":"Beavers","year":"2023","journal-title":"J Card Fail"},{"key":"2026021804003619400_ehf215149-bib-0010","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1002\/ejhf.473","article-title":"Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials","volume":"18","author":"Jankowska","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0011","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004519","article-title":"Definition of iron deficiency based on the gold standard of bone marrow iron staining in heart failure patients","volume":"11","author":"Grote Beverborg","year":"2018","journal-title":"Circ Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0012","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1002\/ehf2.14265","article-title":"Applicability of new proposed criteria for iron deficiency in Japanese patients with heart failure","volume":"10","author":"Tada","year":"2023","journal-title":"ESC Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0013","doi-asserted-by":"publisher","first-page":"497","DOI":"10.2147\/CLEP.S99504","article-title":"The Danish Heart Failure Registry","volume":"8","author":"Schj\u00f8dt","year":"2016","journal-title":"CLEP"},{"key":"2026021804003619400_ehf215149-bib-0014","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.2147\/CLEP.S390898","article-title":"The Danish Heart Failure Registry: a validation study of content","volume":"14","author":"Andersen","year":"2022","journal-title":"CLEP"},{"key":"2026021804003619400_ehf215149-bib-0015","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2147\/CLEP.S17901","article-title":"Existing data sources for clinical epidemiology: the clinical laboratory information system (LABKA) research database at Aarhus University, Denmark","volume":"3","author":"Grann","journal-title":"CLEP"},{"key":"2026021804003619400_ehf215149-bib-0016","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s10654-014-9930-3","article-title":"The Danish civil registration system as a tool in epidemiology","volume":"29","author":"Schmidt","year":"2014","journal-title":"Eur J Epidemiol"},{"key":"2026021804003619400_ehf215149-bib-0017","doi-asserted-by":"publisher","first-page":"449","DOI":"10.2147\/CLEP.S91125","article-title":"The Danish National Patient Registry: a review of content, data quality, and research potential","volume":"7","author":"Schmidt","year":"2015","journal-title":"CLEP"},{"key":"2026021804003619400_ehf215149-bib-0018","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/1403494811399958","article-title":"The Danish Register of Causes of Death","volume":"39","author":"Helweg-Larsen","year":"2011","journal-title":"Scand J Public Health"},{"key":"2026021804003619400_ehf215149-bib-0019","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1093\/ije\/dyw213","article-title":"Data resource profile: the Danish National Prescription Registry","volume":"46","author":"Potteg\u00e5rd","year":"2016","journal-title":"Int J Epidemiol"},{"key":"2026021804003619400_ehf215149-bib-0020","doi-asserted-by":"publisher","first-page":"2078","DOI":"10.1093\/clinchem\/38.10.2078","article-title":"Transferrin index: an alternative method for calculating the iron saturation of transferrin","volume":"38","author":"Beilby","year":"1992","journal-title":"Clin Chem"},{"key":"2026021804003619400_ehf215149-bib-0021","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0022","volume-title":"RStudio: integrated development environment for R","author":"RStudio Team","year":"2022"},{"key":"2026021804003619400_ehf215149-bib-0023","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1159\/000358377","article-title":"Iron deficiency status irrespective of anemia: a predictor of unfavorable outcome in chronic heart failure patients","volume":"128","author":"Rangel","year":"2014","journal-title":"Cardiology"},{"key":"2026021804003619400_ehf215149-bib-0024","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1161\/CIRCULATIONAHA.122.060511","article-title":"Iron deficiency in heart failure and effect of dapagliflozin: findings from DAPA-HF","volume":"146","author":"Docherty","year":"2022","journal-title":"Circulation"},{"key":"2026021804003619400_ehf215149-bib-0025","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1093\/eurheartj\/ehq158","article-title":"Iron deficiency: an ominous sign in patients with systolic chronic heart failure","volume":"31","author":"Jankowska","year":"2010","journal-title":"Eur Heart J"},{"key":"2026021804003619400_ehf215149-bib-0026","doi-asserted-by":"publisher","first-page":"4572","DOI":"10.1002\/ehf2.13617","article-title":"Impact of change in iron status over time on clinical outcomes in heart failure according to ejection fraction phenotype","volume":"8","author":"Fitzsimons","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0027","doi-asserted-by":"publisher","first-page":"2826","DOI":"10.1002\/ehf2.14438","article-title":"Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure","volume":"10","author":"Graham","year":"2023","journal-title":"ESC Heart Fail"},{"key":"2026021804003619400_ehf215149-bib-0028","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1136\/heartjnl-2022-322145","article-title":"Assessment of haemoglobin and serum markers of iron deficiency in people with cardiovascular disease","volume":"109","author":"Graham","year":"2023","journal-title":"Heart"},{"key":"2026021804003619400_ehf215149-bib-0029","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1016\/j.jacc.2011.04.040","article-title":"Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival","volume":"58","author":"Okonko","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0030","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.ijcard.2017.04.110","article-title":"Clinical correlates and prognostic impact of impaired iron storage versus impaired iron transport in an international cohort of 1821 patients with chronic heart failure","volume":"243","author":"Moliner","year":"2017","journal-title":"Int J Cardiol"},{"key":"2026021804003619400_ehf215149-bib-0031","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.1093\/eurheartj\/ehae284","article-title":"Identification of three mechanistic pathways for iron-deficient heart failure","volume":"45","author":"Packer","year":"2024","journal-title":"Eur Heart J"},{"key":"2026021804003619400_ehf215149-bib-0032","doi-asserted-by":"publisher","first-page":"5077","DOI":"10.1093\/eurheartj\/ehad586","article-title":"Efficacy of ferric carboxymaltose in heart failure with iron deficiency: an individual patient data meta-analysis","volume":"44","author":"Ponikowski","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021804003619400_ehf215149-bib-0033","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1002\/ejhf.2810","article-title":"Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis","volume":"25","author":"Graham","year":"2023","journal-title":"Eur J Heart Fail"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/2\/1346\/66952813\/eschf_12_2_1346.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/2\/1346\/66952813\/eschf_12_2_1346.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:00:44Z","timestamp":1771405244000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/12\/2\/1346\/8487960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,6]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,11,6]]},"published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15149","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2024,11,6]]},"assertion":[{"value":"2024-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}