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Iron Deficiency in Heart Failure: An Overview
Stephan von Haehling1, Nicole Ebner1, Ruben Evertz1
1Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
Insights
Iron deficiency is common in heart failure patients, impacting quality of life. Intravenous iron, particularly ferric carboxymaltose, shows efficacy in improving symptoms and potentially reducing hospitalizations and cardiovascular mortality.
Area of Science:
- Cardiology
- Hematology
- Internal Medicine
Background:
- Iron deficiency affects up to 50% of heart failure patients.
- It is linked to decreased exercise capacity, well-being, and quality of life.
Purpose of the Study:
- To review the pathophysiology, prevalence, clinical impact, and treatment of iron deficiency in heart failure.
- To highlight the efficacy of intravenous iron, specifically ferric carboxymaltose.
Main Methods:
- Review of current literature and clinical studies on iron deficiency in heart failure.
- Analysis of data from meta-analyses regarding treatment outcomes.
Main Results:
- Established diagnostic criteria for iron deficiency in heart failure with reduced ejection fraction.
- Intravenous iron, particularly ferric carboxymaltose, improves exercise capacity, quality of life, and functional class.
- Meta-analyses suggest benefits in reducing heart failure hospitalizations and cardiovascular mortality.
Conclusions:
- Iron deficiency is a significant comorbidity in heart failure with clear diagnostic criteria.
- Intravenous iron therapy is preferred over oral iron for efficacy in this patient population.
- Ferric carboxymaltose demonstrates positive effects on key clinical outcomes, with ongoing trials investigating morbidity and mortality benefits.
Abstract:
Iron deficiency is an extremely common comorbidity in patients with heart failure, affecting up to 50% of all ambulatory patients. It is associated with reduced exercise capacity and physical well-being and reduced quality of life. Cutoff values have been identified for diagnosing iron deficiency in heart failure with reduced ejection fraction as serum ferritin, <100 μg/l, or ferritin, 100 to 300 μg/l, with transferrin saturation of <20%. Oral iron products have been shown to have little efficacy in heart failure, where the preference is intravenous iron products. Most clinical studies have been performed using ferric carboxymaltose with good efficacy in terms of improvements in 6-min walk test distance, peak oxygen consumption, quality of life, and improvements in New York Heart Association functional class. Data from meta-analyses also suggest beneficial effects for hospitalization rates for heart failure and reduction in cardiovascular mortality rates. A prospective trial to investigate effects on morbidity and mortality is currently ongoing. This paper highlights current knowledge of the pathophysiology of iron deficiency in heart failure, its prevalence and clinical impact, and its possible treatment options.
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