Iron Deficiency in Heart Failure: Cellular Mechanisms and Therapeutic Implications

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Iron deficiency (ID) is common in heart failure (HF), affecting up to 75% of patients.
• ID contributes to symptoms and poor outcomes in HF, even without anemia.
• Current diagnostics include absolute and functional ID criteria.

Purpose of the Study:

• To review the current understanding of iron deficiency in heart failure.
• To highlight emerging therapeutic strategies for iron deficiency in HF.
• To identify knowledge gaps in diagnosis and treatment.

Main Methods:

• Literature review of major clinical trials (AFFIRM-AHF, IRONMAN, HEART-FID, FAIR-HF2).
• Synthesis of current diagnostic criteria for ID in HF.
• Analysis of European Society of Cardiology guidelines.

Main Results:

• Intravenous iron, especially ferric carboxymaltose, reduces HF hospitalizations.
• Therapy improves quality of life and exercise capacity in HF patients with ID.
• ESC guidelines recommend IV ferric carboxymaltose for symptomatic HFrEF patients with ID.

Conclusions:

• Intravenous iron therapy is a recommended treatment for symptomatic iron-deficient heart failure patients.
• Further research is needed on optimal diagnostics, ferroptosis, and new iron formulations.