Real-world Review of Adherence to Guideline-directed Intravenous Iron Therapy in Heart Failure Patients: A...

International guidelines recommend intravenous (IV) iron replacement in patients with heart failure (HF) with reduced or mildly reduced ejection fraction (HFrEF or HFmrEF) and iron deficiency (ID). IV iron therapy remains underutilised despite growing evidence of its positive impact on hospitalisation rates, quality of life, and symptom control in HF. In this study, we aimed to explore the prevalence of ID and adherence to guideline-directed medical therapy (GDMT) for ID in HF patients.

It was a retrospective observational study performed at a tertiary hospital in Oman. All HF patients admitted between March 2022 and February 2024 were included. ID was defined as serum ferritin less than 100 μg/L or serum ferritin 100-299 μg/L with transferrin saturation (TSAT) of less than 20%. Patients in intensive care units, pregnant women, and those with HF with preserved LVEF (HFpEF) were excluded.

Only 26% (n=97) of 376 patients with HFrEF/HFmrEF were screened for ID, and about half of them (n=52) were found to be iron deficient. ID was tested more often in patients with anemia compared to those without anemia (33.9% vs. 10.7%, p < 0.001). IV iron in the form of iron carboxymaltose (FCM) was administered in 19% of ID patients, but only 15% received the recommended dose of 1000 mg FCM. There was no statistically significant difference in patient demographics or comorbidities between patients with or without ID.

Among 376 HF patients screened for ID, almost half were iron deficient. However, the compliance rate of IV FCM therapy remained quite low. Low screening rates and limited adherence to GDMT underscore the need for standardized hospital protocols for the management of ID in HF patients.