Repletion of Iron Stores With the Use of Oral Iron Supplementation in Patients With Systolic Heart Failure

Niehaus, Emily; Malhotra, Rajeev; Cocca-Spofford, Diane; Semigran, Marc J.; Lewis, Gregory D.

doi:10.1016/j.cardfail.2015.05.006

Cited by 33 publications

(22 citation statements)

References 16 publications

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“…However, in Brazil, a randomised trial (Beck-da-Silva et al, 2013) showed that ferritin and Hb increased with both intravenous and oral iron. Moreover, in a recent, non-randomised clinical trial (Niehaus et al, 2015) oral iron showed improvements in Hb, transferrin saturation and ferritin that were similar to those seen with intravenous iron in the FAIR trial in patients with heart failure and preserved left ventricular ejection fraction (Anker et al, 2009). In Africa, recent studies have begun to explore the role of oral iron in heart failure.…”

Section: Interventions For Iron Deficiency Anaemia In Heart Failure Imentioning

confidence: 73%

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Makubi

Roberts

2017

Br J Haematol

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Summary Frank iron deficiency has been associated with a wide range of cardiac and pulmonary abnormalities including non‐ischaemic cardiomyopathy. Iron deficiency anaemia and isolated iron deficiency are well‐defined adverse prognostic factors in non‐ischaemic cardiac failure. Furthermore, iron‐deficient patients in chronic heart failure with a serum ferritin of <100 μg/l or <300 μg/l with reduced transferrin saturation of <20%, who were given intravenous iron showed improved clinical outcomes. Iron deficiency with or without anaemia affects over a quarter of the world's population, but the impact of iron deficiency in heart failure and the effective management of iron deficiency in heart failure in Lower and Middle Income Countries (LMICs) is not well described. Heart failure in African cohorts occurs at a younger age than in North America and Europe and is more likely to be due to hypertension. Recent studies suggest that iron deficiency anaemia, which is very common in heart failure patients in Africa, and iron deficiency are independently associated with a poor prognosis in heart failure. Preliminary data suggest that iron deficiency in patients with heart failure can be treated with oral iron, with significant beneficial effects on haematological and physiological variables. Cost may prohibit the use of intravenous iron on a large scale in LMICs and optimal regimes to treat iron deficiency in heart failure patients with oral iron therapy remain to be defined.

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Section: Interventions For Iron Deficiency Anaemia In Heart Failure Imentioning

confidence: 73%

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Makubi

Roberts

2017

Br J Haematol

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“…The authors suggested that oral iron supplementation could be an alternative for IV iron, but it is worth noting that after 5 months of the therapy, the level of ferritin was still far below the threshold for an absolute ID in HF (ferritin <100 μg/L). Moreover this study did not reveal any clinical benefits beyond improvement in serum iron indices and haemoglobin; particularly, there was no difference regarding re-hospitalization rates [84]. In another study in HF patients with anaemia, the use of oral iron for 1 year was not associated with any clinical benefits in the context of any improvement in NYHA status, measured exercise endurance, oxygen use during exercise, renal function and plasma B-type natriuretic peptide levels, and the need for hospitalization [85].…”

Section: Oral Iron Supplementationmentioning

confidence: 89%

Iron Therapy in Patients with Heart Failure and Iron Deficiency: Review of Iron Preparations for Practitioners

Drozd

Jankowska

Banasiak³

et al. 2016

Am J Cardiovasc Drugs

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In patients with heart failure (HF), iron deficiency (ID) correlates with decreased exercise capacity and poor health-related quality of life, and predicts worse outcomes. Both absolute (depleted iron stores) and functional (where iron is unavailable for dedicated tissues) ID can be easily evaluated in patients with HF using standard laboratory tests (assessment of serum ferritin and transferrin saturation). Intravenous iron therapy in iron-deficient patients with HF and reduced ejection fraction has been shown to alleviate HF symptoms and improve exercise capacity and quality of life. In this paper, we provide information on how to diagnose ID in HF. Further we discuss pros and cons of different iron preparations and discuss the results of major trials implementing iron supplementation in HF patients, in order to provide practical guidance for clinicians on how to manage ID in patients with HF.

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“…After a median 164 days of oral iron therapy, a significant increase in transferrin saturation (TSAT, from median 9.9-20.8%, P < 0.0001) was observed, which resembled the change in TSAT measured in the FAIR-HF trial (i.e. median from 17.9% to 29% over 180 days) [80,88]. To a lesser extent, although significant, ferritin levels increased as well (median from 40 to 72 µg/L, P < 0.0001), however this was not comparable to the amount of change in ferritin levels in the FAIR-HF trial (median level from 53 to 312 µg/L).…”

Section: Idmentioning

confidence: 63%

“…Finally, one study comprising 105 iron-deficient HFrEF patients retrospectively aimed to assess whether oral iron supplements were able to improve iron status [88]. All patients received oral iron supplementation (median [+interquartile range] daily dose 130 mg) as ferrous sulfate (82%), iron polysaccharide (11%), or ferrous gluconate (7%).…”

Section: Idmentioning

confidence: 99%

Pharmacotherapy for comorbidities in chronic heart failure: a focus on hematinic deficiencies, diabetes mellitus and hyperkalemia

Wal

Beverborg

Veldhuisen³

et al. 2016

Expert Opinion on Pharmacotherapy

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Introduction: Chronic heart failure (HF) is frequently accompanied by one or more comorbidities. The presence of comorbidities in chronic HF is strongly correlated to HF severity and impaired outcome. Areas covered: This review will address several comorbidities with high prevalence and/or high impact in patients with chronic HF, including diabetes, anemia, hematinic deficiencies, and hyperkalemia. The background and subsequent pharmacotherapeutic options of these comorbidities will be discussed. For this review, a MEDLINE search was performed. Expert opinion: Heart failure is increasingly considered a multimorbid syndrome, including metabolic derangements and chronic inflammation. Persistent metabolic derangements and low-grade inflammation might lead to progression of HF and the development of comorbidities. Although several comorbidity-specific drugs became available in the past decade, most of these therapies are studied in relatively small cohorts using surrogate end-points. Therefore, larger studies are needed to address whether treating these comorbidities will improve patient outcome in chronic HF. ARTICLE HISTORY

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Repletion of Iron Stores With the Use of Oral Iron Supplementation in Patients With Systolic Heart Failure

Cited by 33 publications

References 16 publications

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Iron Therapy in Patients with Heart Failure and Iron Deficiency: Review of Iron Preparations for Practitioners

Pharmacotherapy for comorbidities in chronic heart failure: a focus on hematinic deficiencies, diabetes mellitus and hyperkalemia

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