Iron Deficiency in Heart Failure: From ESC Guidelines to Clinical Practice at a Romanian Hospital

Area of Science:

• Cardiology
• Internal Medicine
• Pharmacology

Background:

• Iron deficiency (ID) is a common comorbidity in heart failure (HF), negatively impacting functional capacity and prognosis.
• European Society of Cardiology (ESC) guidelines advocate for systematic ID screening and intravenous iron supplementation (IS) in HF patients.
• Current clinical practice shows limited adherence to these evidence-based recommendations.

Purpose of the Study:

• To evaluate the implementation of ESC guidelines for ID screening and IS in hospitalized HF patients.
• To assess the rates of ID diagnosis and subsequent treatment with intravenous IS.
• To identify patient characteristics associated with receiving IS.

Main Methods:

• Retrospective observational study of 4348 hospitalized HF patients (NYHA II-IV) from January 2018 to September 2022.
• Data collected from electronic medical records included demographics, comorbidities, laboratory results, and echocardiographic findings.
• Intravenous IS was defined as serum ferritin < 100 ng/mL and administration of ferric carbodymaltose.

Main Results:

• Over 58% of HF patients were screened for ID, with 42.8% diagnosed with absolute deficiency.
• Only 25.5% of patients with confirmed ID received intravenous IS (ferric carbodymaltose).
• Patients receiving IS were predominantly elderly, female, and had ischemic or valvular heart disease; they also presented with higher NT-proBNP and troponin levels.

Conclusions:

• A significant gap exists between recommended ID screening/treatment and actual clinical practice in HF.
• Despite high screening rates, less than a quarter of eligible HF patients receive intravenous IS.
• Improved adherence to ESC guidelines is crucial for optimizing outcomes in HF patients with ID.