The Iron Gap: Recognition of Iron Deficiency in Acute Decompensated Heart Failure and In-Hospital Outcomes

Authors

• Ahmad Shrouf, Corewell Health East Resident
• Raghad Shihadat, Corewell Health East Resident
• Mohamed Abdalaziz, Corewell Health East Resident
• Athanasios Rempakos, Corewell Health East Resident
• Aiden Van Loo, Corewell Health East Resident
• Abhay N. Bilolikar, Corewell Health East

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

Background: Guideline-directed evaluation and treatment of iron deficiency (ID) and iron-deficiency anemia (IDA) improve symptoms and reduce recurrent heart failure (HF) hospitalizations, yet recognition during acute decompensated HF (ADHF) admissions is uncertain. Methods: We analyzed adult ADHF hospitalizations in the 2017–2021 Nationwide Inpatient Sample using survey weights. Recognition was defined as documentation of ID/IDA (≥1 diagnosis code). Outcomes included packed red blood cell (RBC) transfusion, in-hospital mortality, length of stay, total cost, and discharge destination. Models adjusted for demographics, payer, comorbidity burden, severity markers, hospital characteristics, and year. Results: Among ~1.21 million weighted ADHF hospitalizations, 8.3% were ID/IDA-documented (vs expected ~40–60%), indicating substantial under-recognition. Documentation was more common at teaching hospitals (RR 1.08, 95% CI 1.06–1.11). ID/IDA documentation was associated with higher RBC transfusion (RR 3.18, 95% CI 3.10–3.26), lower in-hospital mortality (RR 0.62, 95% CI 0.59–0.65), longer length of stay (ratio 1.05, 95% CI 1.04–1.06), and higher costs (ratio 1.04, 95% CI 1.03–1.05). Discharge to non-home was similar. Among transfused hospitalizations, 73.7% lacked an ID/IDA code. Mortality was higher with transfusion vs no transfusion (RR 1.53, 95% CI 1.46–1.59). Conclusions: ID/IDA is markedly under-recognized during U.S. ADHF admissions, including among patients receiving RBC transfusion. Standardized inpatient iron evaluation and documentation pathways may better align care with contemporary evidence.

Volume

5

Issue

4 Suppl

First Page

105238

Comments

 Society for Cardiovascular Angiography and Interventions SCAI 2026 Scientific Sessions & CAIC ACCI Summit, April 23-25, 2026, Montreal, Canada

Last Page

105238

Recommended Citation

Shrouf A, Shihadat R, Abdalaziz M, Rempakos A, Van Loo A, Bilolikar AN. The iron gap: recognition of iron deficiency in acute decompensated heart failure and in-hospital outcomes. J Soc Cardiovasc Angiogr Interv. 2026 Apr;5(4 Suppl):105238. doi:10.1016/j.jscai.2026.105238

DOI

10.1016/j.jscai.2026.105238