Intravenous iron in heart failure: beyond targeting anemia

Area of Science:

• Cardiology
• Hematology
• Nutritional Science

Background:

• Iron deficiency is prevalent in congestive heart failure (CHF) patients, affecting both anemic and non-anemic individuals.
• Iron deficiency can exacerbate CHF symptoms and negatively impact patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of intravenous (IV) iron supplementation in improving clinical parameters in iron-deficient patients with CHF.
• To compare the effects of IV iron versus oral iron in managing iron deficiency in CHF.

Main Methods:

• Systematic review and analysis of six studies investigating IV iron treatment in iron-deficient CHF patients.
• Inclusion of both uncontrolled and controlled studies, including a large double-blind, placebo-controlled trial.
• Comparison with a controlled study examining oral iron's effect on anemia in CHF.

Main Results:

• Five of six studies reported improved hemoglobin levels following IV iron treatment.
• Consistent improvements in New York Heart Association (NYHA) class, quality of life, and exercise capacity were observed with IV iron.
• IV iron also demonstrated improvements in cardiac function in some studies, with rapid benefits in patient global assessment, quality of life, and NYHA class regardless of anemia status.
• Oral iron showed no significant effect on hemoglobin or cardiac parameters in a 1-year controlled study.

Conclusions:

• Intravenous iron therapy is a beneficial treatment for iron-deficient patients with congestive heart failure, irrespective of their anemia status.
• Oral iron supplementation does not appear to be effective for managing iron deficiency in CHF patients.
• IV iron offers a promising therapeutic strategy to improve cardiovascular health and patient-reported outcomes in this population.