PREVALENCE OF IRON-DEFICIENCY ANAEMIA AMONG ADULTS WITH HEART FAILURE IN SOUTH ASIA: A SYSTEMATIC REVIEW IN ACCORDANCE WITH THE PRISMA 2020 STATEMENT

Abstract

Background. Iron deficiency (ID), with or without anaemia, is the most common and most treatable comorbidity in heart failure (HF) and is associated with worse symptoms, reduced exercise capacity, more frequent hospitalisation and higher mortality independent of haemoglobin. South Asia carries one of the world’s heaviest background burdens of iron deficiency and anaemia, yet the frequency of iron-deficiency anaemia specifically among adults with HF in the region has not been synthesised. This systematic review estimates the prevalence of ID, anaemia and true iron-deficiency anaemia (IDA) among South Asian adults with HF. Methods. PubMed/MEDLINE, Embase, Scopus, Web of Science and Google Scholar, together with regional cardiology journals, were searched from inception to July 2026 for observational studies reporting iron status and/or anaemia in adults with HF in South Asian countries. Screening, eligibility assessment and data extraction followed the PRISMA 2020 framework. Study-level prevalence with 95% confidence intervals (CI) was computed, and a random-effects (DerSimonian–Laird) pooled estimate of ID prevalence was derived for studies applying guideline ferritin/transferrin saturation criteria. Methodological quality was appraised with the Hoy risk-of-bias tool for prevalence studies. Results. Eleven studies (India n = 5, Pakistan n = 3, Nepal n = 2, Bangladesh n = 1; total > 2,400 patients) met the criteria. Reported ID prevalence ranged from 45.9% to 89%, and anaemia from 35.8% to 82%. Across seven studies applying guideline criteria, the random-effects pooled ID prevalence was 66.8% (95% CI 55.9–77.8%), with very high heterogeneity (I² = 96%). Iron deficiency measured by ferritin/transferrin saturation was consistently more frequent than anaemia defined by haemoglobin alone. True IDA (concurrent anaemia and ID) was inconsistently reported but, where derivable, affected roughly 35–50% of patients. Female sex, vegetarian diet, advanced NYHA class and a history of bleeding were recurrent correlates of ID. Conclusions. Iron deficiency affects roughly two-thirds of South Asian adults with HF—numerically higher than most Western cohorts—and frequently coexists with, or precedes, overt anaemia. The regional evidence base is small, single centre and definitionally heterogeneous, and true IDA is under-reported. Routine iron-panel screening (ferritin and transferrin saturation) in all South Asian patients with HF, standardised reporting of the ID–anaemia overlap, and adequately powered multicentre studies are priorities.