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International Journal of Cardiology and Cardiovascular Diseases

ISSN: 2768-5640

Original Research Open Access
Volume 6 | Issue 1 | DOI: https://doi.org/10.46439/cardiology.6.035

Evaluating the burden of iron deficiency in heart failure with reduced ejection fraction: a retrospective analysis using the NIS database

Rohab Sohail1,*, Ridda Khattak1, Zaraq Khan2, Hafsa Mansoor3, Madihah Alam4, Shahryar Chaudhry4, Prakhar Anand5, Andrei Feldiorean5, Vyom Patel5, Lindsey Marie Valdiviez5, Ibraheem Murtaza5, Sahil Desai6, Joseph Deutsch7
  • 1Department of Internal Medicine, Bayhealth Medical Center, Dover, Delaware, USA
  • 2Department of Internal Medicine, Indiana University School of Medicine, Southwest, Indiana, USA
  • 3Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur, Punjab, Pakistan
  • 4Department of Internal Medicine, Bayhealth Medical Center, Dover, Delaware, USA
  • 5Department of Internal Medicine, Indiana University School of Medicine, Southwest, Indiana, USA
  • 6Temple University, PA, USA
  • 7Department of Internal Medicine and Graduate Medical Education, Bayhealth Medical Center, Dover, DE, USA
+ Affiliations - Affiliations

Corresponding Author

Rohab Sohail; rohabsohail98@gmail.com

Received Date: December 21, 2025

Accepted Date: March 12, 2026

Citation:

Sohail R, Khattak R, Khan Z, Mansoor H, Alam M, Chaudhry S, et al. Evaluating the Burden of Iron Deficiency in Heart Failure with Reduced Ejection Fraction: A Retrospective Analysis Using the NIS Database. Int J Cardiol Cardiovasc Dis. 2026;6(1):17-23.


Copyright: © 2026 Sohail R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Iron deficiency (ID), prevalent in 10.6% of heart failure with reduced ejection fraction (HFrEF) patients, has been linked to poorer clinical outcomes. The existing literature have provided insight into long-term impacts of the association, but the in-hospital outcomes remain unexplored. This study utilizes data from the National Inpatient Sample (NIS) to bridge this gap.
Method: NIS database for the years 2020 to 2022 was used to identify adult patients (aged ≥18 years) hospitalized with a primary diagnosis of HFrEF. Patients were further stratified based on the presence or absence of ID. Propensity score matching in a 1:1 ratio was performed using STATA, adjusting for age, sex, and relevant comorbidities. Univariate logistic and linear regression analyses were conducted before and after matching to assess clinical outcomes.
Results: Among 6,738,392 patients hospitalized with HFrEF from 2020 to 2022, 398,230 had comorbid ID, predominantly females and Blacks. After 1:1 propensity score matching, 52,930 pairs were analyzed. ID patients had higher rates of acute kidney injury (36.5% vs. 30.3%, OR: 1.30, P<0.001), blood transfusion (64% vs. 36%, OR: 1.89, P<0.001), and longer hospital stay (7.95 vs. 6.92 days, P<0.001). Despite greater resource utilization, they had lower in-hospital mortality (22.1% vs. 27.9%, OR: 0.67, P<0.001), cardiogenic arrest (10.14% vs. 11.17%, OR: 0.91, P=0.03), need for inotropes (5.18% vs. 6.40%, OR: 0.81, P=0.03), ECMO use (0.56% vs. 1.31%, OR: 0.42, P<0.001), and balloon pump insertion (4.3% vs. 6.1%, OR: 0.69, P<0.001).
Conclusion: ID in HFrEF patients is associated with increased rates of acute kidney injury, blood transfusion, and prolonged hospital stay. Despite greater resource utilization, patients with ID demonstrated significantly lower in-hospital mortality and fewer critical interventions. These findings underscore the complex clinical profile of HFrEF patients with concomitant ID and highlight the need for continued research to guide optimal management and improve patient outcomes.

Keywords

Iron deficiency, Heart failure with reduced ejection fraction, In-hospital outcomes, Resource utilization, Mortality, Length of hospital stay

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