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Re-defining iron deficiency in patients with heart failure

J J Cuthbert1,2, N Ransome3, A L Clark2

  • 1Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.

Expert Review of Cardiovascular Therapy
|July 11, 2022
PubMed

Insights

Iron deficiency in chronic heart failure (CHF) is common and impacts prognosis. Current diagnostic methods may be flawed, suggesting a need for better indicators to guide intravenous iron therapy in CHF patients.

Area of Science:

  • Cardiology
  • Hematology
  • Internal Medicine

Background:

  • Iron deficiency (ID) is prevalent in patients with chronic heart failure (CHF), negatively affecting symptoms and outcomes, irrespective of anemia.
  • Randomized controlled trials (RCTs) investigating intravenous (IV) iron for ID in CHF have yielded conflicting results.
  • This review examines the current understanding and future directions for diagnosing and managing ID in CHF.

Purpose of the Study:

  • To review the definition and treatment of iron deficiency in chronic heart failure.
  • To evaluate the limitations of current diagnostic criteria for iron deficiency in CHF.
  • To explore alternative biomarkers for identifying high-risk patients who may benefit from IV iron.

Main Methods:

  • Literature review of existing studies on iron deficiency in chronic heart failure.
  • Analysis of current guideline definitions for iron deficiency.
  • Evaluation of observational data and alternative diagnostic markers.

Main Results:

  • The current definition of ID (serum ferritin <100 µg/L or ferritin 100-299 µg/L and TSAT <20%) is derived from studies in end-stage renal failure and may be inadequate for CHF.
  • Inflammatory cytokines in CHF can affect ferritin levels, potentially masking true iron deficiency.
  • Observational data suggest the current definition fails to identify a high-risk population in CHF.

Conclusions:

  • The existing definition of iron deficiency in CHF may not accurately identify patients who would benefit from IV iron therapy.
  • Alternative markers like low serum iron or transferrin saturation (TSAT) may be more effective in identifying at-risk CHF patients.
  • Further research is needed to refine diagnostic criteria and optimize IV iron treatment strategies for ID in CHF.
Abstract

Keywords:
IV ironIron deficiencyferritinheart failureoutcomeprognosisserum irontransferrin saturations

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