Practical Guidance for Diagnosing and Treating Iron Deficiency in Patients with Heart Failure: Why, Who and How?

Abstract

Iron deficiency (ID) is a comorbid condition frequently seen in patients with heart failure (HF). Iron has an important role in the transport of oxygen, and is also essential for skeletal and cardiac muscle, which depend on iron for oxygen storage and cellular energy production. Thus, ID per se, even without anaemia, can be harmful. In patients with HF, ID is associated with a poorer quality of life (QoL) and exercise capacity, and a higher risk of hospitalisations and mortality, even in the absence of anaemia. Despite its negative clinical consequences, ID remains under-recognised. However, it is easily diagnosed and managed, and the recently revised 2021 European Society of Cardiology (ESC) guidelines on HF provide specific recommendations for its diagnosis and treatment. Prospective randomised controlled trials in patients with symptomatic HF with reduced ejection fraction (HFrEF) show that correction of ID using intravenous iron (principally ferric carboxymaltose [FCM]) provides improvements in symptoms of HF, exercise capacity and QoL, and a recent trial demonstrated that FCM therapy following hospitalisation due to acute decompensated HF reduced the risk of subsequent HF hospitalisations. This review provides a summary of the epidemiology and pathophysiology of ID in HFrEF, and practical guidance on screening, diagnosing, and treating ID.

Iron Deficiency in Heart Failure: A Korea-Oriented Review

“…Indeed, recommendations surrounding the use of IV iron in patients with HF are now included in a number of regional cardiology society guidance documents: the ESC guidelines include a class IIa recommendation to consider the use of IV FCM to reduce the risk of HF hospitalisation in patients with symptomatic HF, LVEF ≤50% and ID who have been recently hospitalised for HF 13) ; and the Asian Pacific Society of Cardiology consensus statements include a recommendation to consider IV FCM in patients with symptomatic chronic HF with reduced (moderate level of evidence; 100% consensus) or mildly reduced (low level of evidence; 100% consensus) ejection fraction who have concomitant ID (defined as serum ferritin <100 ng/mL or serum ferritin 100–299 ng/mL with TSAT <20%). 60) Practical advice on treatment and diagnosis of ID in patients with HF has previously been given 61) ; further considerations are outlined in Figure 4 .…”

Iron Deficiency and Deranged Myocardial Energetics in Heart Failure

“…The etiology of ID in chronic disorders (e.g., HF, chronic kidney disease or chronic obstructive pulmonary disease) is multifactorial, with potential contributing mechanisms including e.g., iron-poor diet, malabsorption, pro-inflammatory state, gastrointestinal bleeding (frequently subclinical) or interactions with certain medications (for example proton pump inhibitors) [ 81 , 88 ]. In patients with HF with reduced left ventricular ejection fraction, ID is highly prevalent and correlates with worse quality of life, lower exercise capacity and eventually increased long-term mortality [ 89 , 90 , 91 , 92 ]. Similar observations have been published for HF patients with preserved left ventricular ejection fraction.…”

Study of H2O2/Cu2+ Catalyzed Oxidation Process of Maltodextrin

“…Inorganic smallmolecule iron compounds, as a solution, can release iron quickly but are toxic; however, large-molecule encapsulated iron compounds can induce antibody formation, resulting in allergic reactions [2]. Ferric carboxymaltose has emerged as an ideal intravenous iron preparation thus far [3][4][5][6]. Current research on ferric carboxymaltose is primarily focused on its clinical application [7][8][9], with little investigation into its preparation process.…”