{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:36:44Z","timestamp":1793313404270,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study was to characterize iron deficiency (ID) in acutely decompensated heart failure (ADHF) and identify whether ID is associated with dyspnea class, length of stay (LOS), biomarker levels, and echocardiographic indices of diastolic function in patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Consecutive patients admitted with ADHF at a single tertiary center were included. Demographic information, pathology investigations, and metrics regarding hospital stay and readmission were recorded. Patients were classified as having \u2018absolute\u2019 ID if they had a ferritin level &lt;100 ng\/mL; or \u2018functional\u2019 ID if they had a ferritin 100\u2013200 ng\/mL and a transferrin saturation &lt;20%. Of 503 patients that were recruited, 270 (55%) had HFpEF, 160 (33%) had HFREF, and 57 (12%) had heart failure with mid-range ejection fraction. ID was present in 54% of patients with HFrEF and 56% of patients with HFpEF. In the HFpEF group, ID was associated with a LOS of 11 \u00b1 7.7 vs. 9 \u00b1 6 days in iron replete patients, p = 0.036, and remained an independent predictor of increased LOS in a multivariate linear regression incorporating comorbidities, age, and ID status. This study corroborates a high prevalence of ID in both HFrEF and HFpEF, and further shows that in patients with HFpEF there is a prolongation of LOS not seen in HFrEF which may indicate a more prominent role for ID in HFpEF.<\/jats:p>","DOI":"10.3390\/jcm8101569","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T11:11:16Z","timestamp":1569928276000},"page":"1569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Iron Deficiency in Acute Decompensated Heart Failure"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3802-1961","authenticated-orcid":false,"given":"Anna","family":"Beale","sequence":"first","affiliation":[{"name":"Baker Heart &amp; Diabetes Institute, 70 Commercial Rd, Melbourne (VIC) 3004, Australia"},{"name":"Cardiology Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne (VIC) 3004, Australia"},{"name":"Monash University, Wellington Rd, Clayton, Melbourne (VIC) 3800, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Carballo","sequence":"additional","affiliation":[{"name":"Service of Cardiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4452","authenticated-orcid":false,"given":"Jerome","family":"Stirnemann","sequence":"additional","affiliation":[{"name":"Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Garin","sequence":"additional","affiliation":[{"name":"Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Agoritsas","sequence":"additional","affiliation":[{"name":"Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Serratrice","sequence":"additional","affiliation":[{"name":"Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kaye","sequence":"additional","affiliation":[{"name":"Baker Heart &amp; Diabetes Institute, 70 Commercial Rd, Melbourne (VIC) 3004, Australia"},{"name":"Cardiology Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne (VIC) 3004, Australia"},{"name":"Monash University, Wellington Rd, Clayton, Melbourne (VIC) 3800, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Meyer","sequence":"additional","affiliation":[{"name":"Service of Cardiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Carballo","sequence":"additional","affiliation":[{"name":"Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"Klip","year":"2013","journal-title":"Am. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Martens, P., Nijst, P., Verbrugge, F.H., Smeets, K., Dupont, M., and Mullens, W. (2017). Impact of iron deficiency on exercise capacity and outcome in heart failure with reduced, mid-range and preserved ejection fraction. Acta Cardiol.","DOI":"10.1080\/00015385.2017.1351239"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/ejhf.236","article-title":"Iron therapy for the treatment of iron deficiency in chronic heart failure: Intravenous or oral?","volume":"17","author":"McDonagh","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.hlc.2015.06.827","article-title":"Iron Deficiency in Heart Failure: Looking Beyond Anaemia","volume":"25","author":"Wong","year":"2016","journal-title":"Heart Lung Circ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMra041809","article-title":"Anemia of Chronic Disease","volume":"352","author":"Weiss","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","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":"ref_7","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.cardfail.2011.08.003","article-title":"Iron Deficiency Predicts Impaired Exercise Capacity in Patients with Systolic Chronic Heart Failure","volume":"17","author":"Jankowska","year":"2011","journal-title":"J. Card. Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1093\/eurjhf\/hft083","article-title":"Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status","volume":"15","author":"Enjuanes","year":"2013","journal-title":"Eur. J. Heart Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/eurjhf\/hfs017","article-title":"Iron supplementation for the treatment of chronic heart failure and iron deficiency: Systematic review and meta-analysis","volume":"14","author":"Avni","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.cjca.2015.06.009","article-title":"The Efficacy and Safety of Iron Supplementation in Patients with Heart Failure and Iron Deficiency: A Systematic Review and Meta-analysis","volume":"32","author":"Qian","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1002\/ejhf.823","article-title":"Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: An individual patient data meta-analysis","volume":"20","author":"Anker","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_12","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":"Ponikowski","year":"2017","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1001\/jama.2017.5427","article-title":"Effect of Oral Iron Repletion on Exercise Capacity in Patients with Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial","volume":"317","author":"Lewis","year":"2017","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ijcard.2016.01.187","article-title":"Iron deficiency and functional capacity in patients with advanced heart failure with preserved ejection fraction","volume":"207","author":"Dominguez","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1002\/ejhf.513","article-title":"Iron deficiency and risk of early readmission following a hospitalization for acute heart failure","volume":"18","author":"Minana","year":"2016","journal-title":"Eur. J. Heart Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1093\/eurheartj\/ehu067","article-title":"Heart failure with preserved ejection fraction: A clinical dilemma","volume":"35","author":"Komajda","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/ejhf.139","article-title":"High prevalence of iron deficiency in patients with acute decompensated heart failure","volume":"16","author":"Damy","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1016\/j.jacc.2006.08.034","article-title":"Etiology of Anemia in Patients with Advanced Heart Failure","volume":"48","author":"Nanas","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/ejh.12776","article-title":"Epidemiology of iron deficiency anaemia in four European countries: A population-based study in primary care","volume":"97","author":"Levi","year":"2016","journal-title":"Eur. J. Haematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s11897-013-0155-7","article-title":"The emerging epidemic of heart failure with preserved ejection fraction","volume":"10","author":"Oktay","year":"2013","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s00392-014-0788-x","article-title":"Sex differences in new-onset heart failure","volume":"104","author":"Meyer","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e003989","DOI":"10.1161\/JAHA.116.003989","article-title":"Biomarker Profiles in Heart Failure Patients with Preserved and Reduced Ejection Fraction","volume":"6","author":"Tromp","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"676S","DOI":"10.1093\/jn\/131.2.676S","article-title":"Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship","volume":"131","author":"Haas","year":"2001","journal-title":"J. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Houstis, N.E., Eisman, A.S., Pappagianopoulos, P.P., Wooster, L., Bailey, C.S., Wagner, P.D., and Lewis, G.D. (2017). Exercise Intolerance in HFpEF: Diagnosing and Ranking its Causes Using Personalized O2 Pathway Analysis. Circulation, 148\u2013161.","DOI":"10.1161\/CIRCULATIONAHA.117.029058"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.amjcard.2016.09.017","article-title":"Impact of Iron Deficiency on Response to and Remodeling After Cardiac Resynchronization Therapy","volume":"119","author":"Martens","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"H585","DOI":"10.1152\/ajpheart.00463.2008","article-title":"Adaptive response of the heart to long-term anemia induced by iron deficiency","volume":"296","author":"Naito","year":"2009","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","article-title":"A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation","volume":"62","author":"Paulus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sanders-Van Wijk, S., Van Empel, V., Davarzani, N., Maeder, M.T., Handschin, R., Pfisterer, M.E., Brunner-La Rocca, H.P., and TIME-CHF investigators (2015). Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction. Eur. J. Heart Fail., 17.","DOI":"10.1002\/ejhf.414"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"568S","DOI":"10.1093\/jn\/131.2.568S","article-title":"Iron Biology in Immune Function, Muscle Metabolism and Neuronal Functioning","volume":"131","author":"Beard","year":"2001","journal-title":"J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.jacc.2011.11.040","article-title":"Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction","volume":"59","author":"Ather","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3587","DOI":"10.3390\/nu6093587","article-title":"Obesity as an Emerging Risk Factor for Iron Deficiency","volume":"6","author":"Aigner","year":"2014","journal-title":"Nutrients"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1016\/j.ijcard.2013.01.249","article-title":"The missed opportunities to diagnose and treat iron deficiency in patients hospitalized with heart failure","volume":"168","author":"Silverberg","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_34","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":"ref_35","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 deficiencydagger","volume":"36","author":"Ponikowski","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1056\/NEJMoa1707914","article-title":"Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease","volume":"377","author":"Ridker","year":"2017","journal-title":"N. Engl. J. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/10\/1569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:26:37Z","timestamp":1760189197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/10\/1569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["jcm8101569"],"URL":"https:\/\/doi.org\/10.3390\/jcm8101569","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,1]]}}}