{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T23:04:26Z","timestamp":1775689466917,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":831,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T00:00:00Z","timestamp":1693094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","award":["CL-2019-15-001"],"award-info":[{"award-number":["CL-2019-15-001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>There is uncertainty about the definition of iron deficiency (ID) and the association between ID and prognosis in patients with advanced heart failure. We evaluated three definitions of ID in patients referred for heart transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Consecutive patients assessed for heart transplantation at a single UK centre between January 2010 and May 2022 were included. ID was defined as (1) serum ferritin concentration of &amp;lt;100\u2009ng\/ml, or 100\u2013299\u2009ng\/ml with transferrin saturation &amp;lt;20% (guideline definition), (2) serum iron concentration \u226413\u2009\u03bcmol\/L, or (3) transferrin saturation &amp;lt;20%. The primary outcome measure was a composite of all-cause mortality, urgent heart transplantation or need for mechanical circulatory support. Overall, 801 patients were included, and the prevalence of ID was 39\u201355% depending on the definition used. ID, defined by either serum iron or transferrin saturation, was an independent predictor of the primary outcome measure (hazard ratio [HR] 1.532, 95% confidence interval [CI] 1.264\u20131.944, and HR 1.595, 95% CI 1.323\u20132.033, respectively), but the same association was not seen with the guideline definition of ID (HR 1.085, 95% CI 0.8827\u20131.333). These findings were robust in multivariable Cox regression analysis. ID, by all definitions, was associated with lower 6-min walk distance, lower peak oxygen consumption, higher intra-cardiac filling pressures and lower cardiac output.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Iron deficiency, when defined by serum iron concentration or transferrin saturation, was associated with increased frequency of adverse clinical outcomes in patients with advanced heart failure. The same association was not seen with guideline definition of ID.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2949","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T02:33:47Z","timestamp":1693190027000},"page":"2067-2074","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Prognostic Value of Three Iron Deficiency Definitions in Patients with Advanced Heart Failure"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1647-920X","authenticated-orcid":false,"given":"Charikleia","family":"Papadopoulou","sequence":"first","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]},{"name":"Department of Medicine, University of Cambridge , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2412-2574","authenticated-orcid":false,"given":"Johannes","family":"Reinhold","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]},{"name":"Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia , Norwich ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolai","family":"Gr\u00fcner-Hegge","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Kydd","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai","family":"Bhagra","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Jayan","family":"Parameshwar","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clive","family":"Lewis","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Martinez","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Pettit","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital , Cambridge ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,8,27]]},"reference":[{"key":"2026010913113426300_ejhf2949-bib-0001","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1056\/NEJMoa0908355","article-title":"Ferric carboxymaltose in patients with heart failure and iron deficiency","volume":"361","author":"Anker","year":"2009","journal-title":"N Engl J Med"},{"key":"2026010913113426300_ejhf2949-bib-0002","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/eurheartj\/ehu385","article-title":"Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency","volume":"36","author":"Ponikowski","year":"2015","journal-title":"Eur Heart J"},{"key":"2026010913113426300_ejhf2949-bib-0003","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1161\/CIRCULATIONAHA.117.027497","article-title":"Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency","volume":"136","author":"van Veldhuisen","year":"2017","journal-title":"Circulation"},{"key":"2026010913113426300_ejhf2949-bib-0004","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/S0140-6736(22)02083-9","article-title":"Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): An investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial","volume":"400","author":"Kalra","year":"2022","journal-title":"Lancet"},{"key":"2026010913113426300_ejhf2949-bib-0005","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","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). 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