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Towards Holistic Heart Failure Management-How to Tackle the Iron Deficiency Epidemic?
Lucas N L Van Aelst1,2,3, Dominiek Mazure4, Alain Cohen-Solal5,6,7
1Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg O&N1, Herestraat 49, box 911, 3000, Leuven, Belgium.
Insights
Iron deficiency (ID) is a common comorbidity in heart failure (HF). Intravenous iron effectively treats ID in HF, improving symptoms and quality of life, unlike oral iron supplements.
Area of Science:
- Cardiology
- Hematology
- Internal Medicine
Background:
- Heart failure (HF) is a prevalent and serious condition often accompanied by comorbidities.
- Iron deficiency (ID) is increasingly recognized as a frequent and impactful comorbidity in HF patients.
- Understanding the interplay between HF and ID is crucial for effective patient management.
Purpose of the Study:
- To review recent evidence on iron deficiency in heart failure.
- To discuss the epidemiology, causes, and clinical consequences of ID in HF.
- To highlight advancements in treating ID in HF patients.
Main Methods:
- Literature review focusing on studies published in the last five years.
- Analysis of current evidence regarding iron deficiency diagnosis and management in HF.
- Synthesis of findings on the efficacy of different iron replacement strategies.
Main Results:
- Intravenous iron administration improves symptoms, quality of life, and exercise capacity in HF patients with ID.
- Oral iron is ineffective due to elevated hepcidin levels in HF, which inhibit iron absorption.
- Intravenous iron is the recommended treatment for ID in heart failure.
Conclusions:
- Iron deficiency is a significant and treatable comorbidity in heart failure.
- Intravenous iron offers substantial benefits for HF patients with ID.
- Further research is needed to address remaining questions regarding ID management in HF.
Purpose Of Review:
Heart failure (HF) is a common, costly, disabling, and deadly clinical syndrome and often associated with one or several co-morbidities complicating its treatment or worsening its symptoms. During the last decade, iron deficiency (ID) got recognized as a frequent, debilitating yet easily treatable co-morbidity in HF. In this review, we focus on new evidence that emerged during the last 5 years and discuss the epidemiology, the causes, and the clinical consequences of ID in HF.
Recent Findings:
Apart from replenishing iron stores, intravenous iron improves patients' symptoms, perceived quality of life (QoL), exercise capacity, and hospitalization rates. These beneficial effects cannot be attributed to oral iron, as increased hepcidin levels, typical in inflammatory states such as HF, preclude resorption of iron from the gut. Intravenous iron is the only valid treatment option for ID in HF. However, there are several burning research questions and gaps in evidence remaining in this research field.
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