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Abstract
Introduction Vitamin D insufficiency is common within the Irish population and heart failure (HF) patients are particularly at risk. Moreover, elderly HF patients are at risk of reduced sun exposure leading to reduction in vitamin D level. Various studies had investigated the role of vitamin D in improving outcome in heart failure and low vitamin D correlates to poor prognosis in patients with left ventricular assist device. Routine vitamin D blood measurement is not part of HF follow-up as per ESC guidelines, yet it is vital in general well-being of patients. The aim of this study is to examine temporal vitamin D pattern in all heart failure subtypes patients attending the Heart Support Unit (HSU) Beaumont Hospital.
Method 343 consecutive patients attending HSU from period January to December 2017 were included. Vitamin D, ntProBNP, eGFR, creatinine, calcium, phosphate, and albumin levels was extracted. Descriptive statistical analysis was calculated. Range was described as median with inter-quartile range.
Result Data was available in 294 of the 343 heart failure patients, 170 male (77 [65:83] years, 57.8%) and 124 female (81 [74:85] years, 42.2%) patients. Only 91 (30.9%) patients (48 were female) had vitamin D level checked at least once within the year. Female patients display bimodal dipping of vitamin D concentration reaching the level of insufficiency (<50 umol/L) during winter and autumn (figure 1). In the female cohort, vitamin D level was deficient at 15 [10:14] nmol/L mid-winter versus 67 [14:107] nmol/L in mid-summer. 276 (93.9%) patients had ntProBNP level in 2017 with eGFR of 47.6 [33.4:64.7] (mL/min/1.73 m²). Creatinine was marginally lower in male (122 [102:152] umol/L) compared to female (144 [80:152] umol/L). Calcium and Phosphate levels were normal, 2.3 [2.2:2.4] umol/L (both), and 1.0 [0.86:1.2] mol/L in male and 1.1 [0.98:1.3] umol/L in female. Albumin level was normal (37 [32:40] umol/L vs 37 [34:39] umol/L) respectively.
Vitamin D concentration
Conclusions Vitamin D levels are not routinely check in HF patients especially in those who have impaired renal function which impacts on vitamin D metabolism but without obvious perturbations in calcium or phosphate homeostasis in this cohort. The temporal vitamin D pattern in female cohort dipped in winter and autumn, that may reflect the seasonal exposure to sun. Interestingly, no bimodal pattern observed in level of vitamin D in male heart failure cohort, possibly due to more engagement in physical activity outdoors. These finding suggest the need for routine vitamin D measurement and treatment in heart failure patients.