Date Published: 
Tuesday, 22 April, 2014

Iron deficiency in cardiology

Iron deficiency is a common, yet under-diagnosed, co-morbidity of heart disease which has a significant and detrimental effect on clinical outcome1-3.

Patients with iron deficiency have an increased risk of heart transplantation, increased morbidity, and reduced exercise capacity and quality of life1,2,4. Furthermore, iron deficiency has been repeatedly and independently associated with a marked increase in mortality in patients with heart disease1,3,5,6. As such, the successful treatment of iron deficiency in patients with chronic heart failure has the potential to significantly improve overall clinical outcome, reducing morbidity and mortality rates, as well as restore quality of life.

Iron deficiency is an independent co-morbidity

Although prevalent in a range of heart conditions, iron deficiency is a particular problem for those with chronic disease, including chronic heart failure. The growing significance of iron deficiency is evidenced by its inclusion as a co-morbidity in its own right – independently of anaemia – in the 2012 European Society of Cardiology guidelines for acute and chronic heart failure6.

These guidelines reinforce the importance of regularly monitoring for signs of iron deficiency and the need for effective diagnosis and treatment, regardless of the presence of anaemia. This is further highlighted by three independent studies, which together show that non-anaemic iron-deficient patients with chronic heart failure have up to a two-fold greater risk of death than anaemic iron-replete patients1-3.

Table 1. Conditions for which iron deficiency is a common co-morbidity7-13.


An estimated 37–50% of patients with chronic heart failure are iron deficient, defined as a serum ferritin level <100 µg/L or 100–300 µg/L with a transferrin saturation <20%3,5. These patients typically experience a reduced quality of life that is equal to or greater than that observed with other chronic medical conditions, such as diabetes, arthritis and chronic lung disease.