Iron deficiency in chronic heart failure with preserved ejection fraction

Chronic heart failure with preserved ejection fraction (HFpEF) is a syndrome characterized by a wide range of comorbidities. Considering the role of iron in cellular activity, iron deficiency (ID) may play a significant role in patients with HFpEF. However, the impact of ID on the quality of life and functional status of these patients has not been well studied, and available data are limited due to the small number of studies with conflicting results. Objective: To assess the contribution of ID to the severity of clinical manifestations of heart failure and its impact on FS and QoL indicators in patients with HFpEF. Material and methods. This study was conducted as part of a prospective, randomized cohort study to investigate the effect of ferric carboxymaltose on the quality of life and clinical presentation of HFpEF in patients with ID. To assess the impact of ID on the clinical course of HFpEF and its impact on quality of life, 73 patients were enrolled based on specific inclusion criteria. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MHFLQ) and the SF-36 questionnaire, while functional status was evaluated through the 6-minute walk test (6MWT). Results. The prevalence of ID among the study group was 61.6%. Iron deficiency anemia (IDA) was reported in only 17.8% of these individuals. Of the 73 participants included in the study, 68.9% were women. The median age of patients was 67 years (range 62–71.3). In the group with IDA, a more severe heart failure functional class III was recorded somewhat more frequently (p = 0.075). Symptoms of heart failure, such as shortness of breath, palpitations, and weakness/fatigue, were more common in patients with IDA compared to those without iron deficiency (p < 0.05, p < 0.001, p = 0.001). The 6MWT values were significantly lower in the group with IDA than in those without (p = 0.024). Analysis of quality of life using the MHFLQ revealed a more significant decrease in quality of life among patients with IDA (p = 0.011). According to the SF-36 questionnaire, we found that in the group of patients with ID, indicators of physical activity, vital activity, and general perception of health were significantly lower compared to the control group (p < 0.001). Additionally, mental health indicators were also significantly lower (p < 0.001). Conclusion. Iron deficiency, with or without anemia, is a common condition among patients with HFpEF, detected in more than half of this cohort. Iron deficiency, regardless of whether it is accompanied by anemia, is linked to a reduction in physical performance and a decline in quality of life related to both the physical and mental components of health.