TOPLINE

Only about one third of patients with incident heart failure had ferritin testing for iron deficiency within a year of diagnosis, with increasing age and long-term conditions — such as coeliac disease and type 1 diabetes — associated with higher odds of testing.

METHODOLOGY

• Researchers conducted a retrospective cohort study using primary care data in the UK from 2016 to 2021 to assess ferritin testing after the diagnosis of incident heart failure.
• A total of 105,749 adult patients with a diagnosis of incident heart failure (mean age at diagnosis, 71.6 years; 44.7% women) who had at least 12 months of follow-up data were included.
• The primary outcome was a coded ferritin test within a year of diagnosis; repeat testing within the following year among those initially tested was also assessed.
• Associations between various patient characteristics and odds of receiving ferritin testing were also assessed.

TAKEAWAY

• Only 33.7% of patients with incident heart failure had a ferritin test within a year of diagnosis, and among those initially tested, only 37.3% had a repeat test in the following year.
• Odds of testing rose with age (odds ratio [OR], 1.25 per 10-year increase; P < .001), and men had lower odds of testing than women (OR, 0.86; P < .001).
• Patients with coeliac disease (OR, 1.86), type 1 diabetes (OR, 1.82), and cirrhosis (OR, 1.64) had the highest odds of ferritin testing among the comorbid conditions examined (P < .001 for all). These conditions were also associated with increased odds of repeat ferritin testing.
• Among patients diagnosed with heart failure alone without other long-term conditions, 23.2% underwent ferritin testing within 1 year of diagnosis; they had the lowest odds of ferritin testing (OR, 0.66; P < .001).

IN PRACTICE

"Increased testing and earlier identification of iron deficiency could improve clinical outcomes and reduce healthcare costs associated with recurrent hospitalisation or functional decline," the authors wrote.

SOURCE

The study was led by Vijay Maharajan, MB BChir, MSc, Royal Brompton Hospital Centre of Excellence, Guy's and St Thomas' NHS Foundation Trust, London, and Nicholas Robert Jones, DPhil, MBBS, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, both in England. It was published online on July 31, 2026, in BJGP Open.

LIMITATIONS

The study analysis relied on primary care codes, so ferritin tests performed in secondary care that were not transcribed into the primary care record may have led to an underestimation of testing. Most patients lacked a code categorising heart failure by left ventricular ejection fraction. The reason for testing was not captured.

DISCLOSURES

The study was supported in part by the UK National Institute for Health and Care Research Blood and Transplant Research Unit in Data Driven Transfusion Practice. One author received support from the Oxford and Thames Valley Applied Research Collaboration. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.