Prevalence of Absolute and Functional Iron Deficiency in Adults with Heart Failure at a Tertiary Hospital in Saudi Arabia

Abstract

Objective: To estimate the prevalence of absolute and functional ID in adults with heart failure in a tertiary hospital in Saudi Arabia.

Design, Setting, and Participants: This cross-sectional study included patients enrolled in the Heart Failure Program at King Abdullah Medical City between March 2023 and March 2025. Eligible participants had available ferritin, serum iron, and unsaturated iron-binding capacity measurements : To estimate the prevalence of absolute and functional ID in adults with heart failure

Main Outcomes and Measures: Absolute ID was defined as ferritin <100 ng/mL, regardless of transferrin saturation (TSAT). Functional ID was defined as ferritin 100–300 ng/mL with TSAT <20%.

Results: Among 190 patients with heart failure with reduced ejection fraction (mean age 61 ± 13 years; 32% female), 43% had absolute ID and 16% had functional ID. Mortality and, hospitalization was not different , Female patients had significantly lower hgb compared with males (10.7 ± 1.8 vs 12.7 ± 2.7 g/dL; P<0.001). Serum iron was slightly higher in males (58.3 ± 32.5 vs 48.9 ± 27.8 µg/dL; P=0.052), while ferritin levels were comparable (189.6 ± 294 vs 165 ± 180 ng/mL; P=0.58). TSAT was numerically higher in males (46 ± 84.8 vs 19 ± 10; P=0.134). Intravenous (IV) iron was administered more frequently to females (27.9% vs 9.0%; P=0.006). Iron supplementation was documented in 24.1% of patients with absolute ID and 21.2% with functional ID. Patients with ID and anemia were far more likely to receive IV iron than those without anemia (43.9% vs 3.3%; P=0.001).

Conclusions and Relevance: Absolute ID is nearly three times as prevalent as functional ID among Saudi patients with heart failure. Hemoglobin, rather than iron indices, appears to drive IV iron therapy decisions, underscoring the need for improved recognition and treatment of ID, even without anemia.