Determining the Role of Thiamine Deficiency in Systolic Heart Failure: A Meta-Analysis and Systematic Review.
BACKGROUND
Approximately 5.7 million Americans carry the diagnosis of systolic heart failure (HF), a major health care burden. HF is a known manifestation of thiamine deficiency (TD). HF patients are at unique risk for developing TD, which may contribute to further altered cardiac function and symptoms.


RESULTS
We performed a systematic review of the literature and a meta-analysis to evaluate the prevalence of TD in HF patients, risk factors for and mechanisms of development of TD in HF population, and outcomes of thiamine supplementation in HF patients. We found 54 studies that met our selection criteria, 9 of which were suitable for meta-analysis. TD is more common in HF patients than control subjects (odds ratio 2.53, 95% confidence interval 1.65-3.87). Diuretic use, changes in dietary habits, and altered thiamine absorption and metabolism were identified as possible mechanisms of TD in HF patients. Small observational studies and randomized control trials suggest that thiamine supplementation in HF population may improve ejection fraction and reduce symptoms.


CONCLUSIONS
Thiamine deficiency is more prevalent in the HF population, and its supplementation may be beneficial. The therapeutic role of thiamine in HF warrants further study.
Division of Hospital Medicine, University of Florida, Gainesville, Florida. Electronic address: ankur.jain@medicine.ufl.edu.
Ankur
A
Jain
Division of Hospital Medicine, University of Florida, Gainesville, Florida.
Raj
R
Mehta
Department of Internal Medicine, University of Florida, Gainesville, Florida.
Mohammad
M
Al-Ani
Division of Cardiology, University of Florida, Gainesville, Florida.
James A
JA
Hill
Division of Cardiology, University of Florida, Gainesville, Florida.
David E
DE
Winchester
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013831:Thiamine / Q000008:administration & dosage*; D013832:Thiamine Deficiency / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D014463:Ultrasonography
D013831:Thiamine
Thiamine deficiency; heart failure; meta-analysis