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Implementation of guidelines for intravenous iron therapy in heart failure patients

Milou Gamage1, Aristomenis Manouras1,2,3, Camilla Hage1,2,3

  • 1Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden.

ESC Heart Failure
|June 21, 2025
PubMed

Insights

In heart failure patients, 54% were screened for iron deficiency, with screened individuals showing more advanced disease. This highlights the potential of national registries to improve patient care and treatment adherence.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Iron deficiency is common in heart failure (HF) and impacts patient outcomes.
  • The 2021 ESC Guidelines recommend screening and treatment for iron deficiency in HF patients.
  • Implementation of these guidelines requires evaluation in clinical practice.

Purpose of the Study:

  • To assess the adherence to 2021 ESC Guidelines for iron deficiency screening and treatment in heart failure patients at Karolinska University Hospital.
  • To identify characteristics of screened versus unscreened patients.

Main Methods:

  • Retrospective analysis of 261 heart failure patients (LVEF < 50%, NYHA class II-IV) from the SwedeHF registry (2021).
  • Data extraction included patient characteristics, iron deficiency screening, ferric carboxymaltose (FCM) administration, and HF medications.
  • Comparison of screened (n=141) and unscreened patients.

Main Results:

  • 54% of eligible heart failure patients were screened for iron deficiency.
  • Screened patients had significantly lower LVEF, higher NT-proBNP levels, and a higher prevalence of diabetes.
  • Screened patients were more likely to receive SGLT2 inhibitors and loop diuretics; those treated with IV iron had higher NYHA class.

Conclusions:

  • The study found that 54% of heart failure patients with reduced or mid-range ejection fraction were screened for iron deficiency.
  • Screened patients exhibited more severe HF, suggesting increased medical attention and guideline adherence.
  • National quality registries are effective tools for monitoring outcomes and improving patient care in heart failure management.
Abstract

Keywords:
GuidelinesHeart failureImplementation scienceIron deficiency

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