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Pathophysiology and Treatment Opportunities of Iron Deficiency in Heart Failure: Is There a Need for Further Trials?
Michał Tkaczyszyn1,2, Marat Fudim3,4, Piotr Ponikowski5,6
1Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland. michal.tkaczyszyn@umw.edu.pl.
Insights
Iron deficiency in heart failure (HF) requires careful management. Intravenous iron, like ferric carboxymaltose (FCM), can improve quality of life and reduce hospitalizations in HF patients with iron deficiency (ID).
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Iron deficiency (ID) is a common comorbidity in heart failure (HF) with complex pathophysiology.
- Intravenous iron therapy is increasingly recognized for its benefits in HF patients.
Purpose of the Study:
- To review the role of intravenous iron therapy in heart failure patients with iron deficiency.
- To discuss the class effect of intravenous iron formulations and compare experiences from nephrology.
- To address ongoing clinical questions regarding iron supplementation in HF.
Main Methods:
- Review of current literature and clinical experiences.
- Discussion of intravenous iron formulations beyond ferric carboxymaltose (FCM).
- Exploration of oral iron therapy and its effects in HF.
Main Results:
- Intravenous iron (FCM) can improve quality of life, exercise capacity, and reduce HF hospitalizations.
- Experiences from nephrology suggest a potential class effect for intravenous iron formulations.
- Oral iron therapy shows neutral effects in HF patients, warranting further investigation.
Conclusions:
- Intravenous iron therapy should be considered for stable HF patients with ID.
- Further research is needed on optimal iron replenishment strategies in HF, including interactions with other medications like SGLT2 inhibitors.
Purpose Of Review:
Iron deficiency (ID) complicates heart failure (HF) at different stages of the natural history of the disease; however, this frequent comorbidity is still not comprehensively understood and investigated in terms of pathophysiology. Intravenous iron therapy with ferric carboxymaltose (FCM) should be considered to improve the quality of life, exercise capacity, and symptoms in stable HF with ID, as well as to reduce HF hospitalizations in iron-deficient patients stabilized after an episode of acute HF. The therapy with intravenous iron, however, continues to generate important clinical questions for cardiologists.
Recent Findings:
In the current paper, we discuss the class effect concept for intravenous iron formulations beyond FCM, based on the experiences of nephrologists who administer different intravenous iron formulations in advanced chronic kidney disease complicated with ID and anemia. Furthermore, we discuss the neutral effects of oral iron therapy in patients with HF, because there are still some reasons to further explore this route of supplementation. The different definitions of ID applied in HF studies and new doubts regarding possible interactions of intravenous iron with sodium-glucose co-transporter type 2 inhibitors are also emphasized. The experiences of other medical specializations may provide new information on how to optimally replenish iron in patients with HF and ID.
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