title: Iron deficiency and risk of early readmission following a hospitalization for acute heart failure.
abstract: Early rehospitalization after an episode of acute heart failure (AHF) remains excessively high and its prediction a contemporary challenge. Iron deficiency (ID) is a frequent finding in AHF, but its prognostic implications remain unclear. We sought to evaluate the association between ID and risk of 30-day readmission in an unselected cohort of patients discharged for AHF.
  
  
  
  Serum ferritin and transferrin saturation (TSAT) were measured before discharge in 626 consecutive patients with AHF in a single teaching centre. ID was defined as serum ferritin <100 µg/L (absolute ID) or ferritin 100-299 µg/L with a TSAT <20% (functional ID). Cox regression adapted for competing events was used to determine the association between ID and the risk of 30-day readmissions. Mean age was 73.4 ± 10.4 years, 48% were females, and 52.1% showed an LVEF >50%. ID was identified in 463 patients (74%): 302 (48.2%) as absolute ID and 161 (25.7%) as functional ID. At 30-day post-discharge, 20 (3.2%) patients died and 103 (16.5%) were readmitted. Patients with absolute ID showed an increased rate of readmission compared with those with functional ID and no ID (19.9, 13, and 13.5%, respectively, P = 0.005). In a multivariate setting, absolute ID remained associated with higher risk of readmission [hazard ratio (HR) 1.72; 95% confidence interval (CI) 1.13-2.60, P = 0.011]. Compared with patients without ID, functional ID was not related to the risk of readmission (HR 0.87; 95% CI 0.46-1.62, P = 0.652).
  
  
  
  In patients with AHF, absolute ID, but not functional ID, was associated with an increased risk of early readmission.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.affiliation: Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Comín-Colet
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mollar
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Valero
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Cardells
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003677:Deficiency Diseases / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D005293:Ferritins / Q000097:blood; D006333:Heart Failure / Q000453:epidemiology*; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D014168:Transferrin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D014168:Transferrin; D005293:Ferritins; D007501:Iron
keywords: Acute heart failure; Iron deficiency; Rehospitalization