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Multidisciplinary approach to implementing ferric carboxymaltose for IV iron replacement in heart failure with iron

Marat Fudim1,2, Francesco Ferrante3, Cassandra M Vorgang4

  • 1Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.

Future Cardiology
|June 3, 2026
PubMed

Insights

Iron deficiency in heart failure patients improves with intravenous iron. This guide offers a workflow to ensure iron repletion and optimize outcomes for heart failure patients with iron deficiency.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Iron deficiency (ID) is a frequent comorbidity in heart failure (HF) patients.
  • Intravenous (IV) iron is guideline-recommended to enhance HF symptoms, exercise capacity, quality of life, and reduce hospitalizations.
  • Ferric carboxymaltose (FCM) is approved for ID in adults with HF (NYHA class II/III) to improve exercise capacity.

Purpose of the Study:

  • To present a general workflow for routine iron assessment and IV iron repletion in HF care pathways.
  • To address challenges in achieving iron repletion in routine practice, such as formulary restrictions and care transitions.
  • To emphasize a multidisciplinary approach involving cardiologists, nurses, APPs, and pharmacists.

Main Methods:

  • The guide outlines a workflow implemented in university-based and private hospital systems.
  • It incorporates perspectives from various healthcare professionals (cardiologist, nurse, APP, pharmacist).
  • Focuses on facilitating iron assessment and IV iron repletion within a typical HF care pathway.

Main Results:

  • The workflow aims to overcome barriers to optimal iron repletion in HF patients.
  • It highlights the importance of collaboration among healthcare providers.
  • Facilitates consistent iron assessment and treatment delivery.

Conclusions:

  • A multidisciplinary, collaborative approach is crucial for optimizing outcomes in HF patients with ID.
  • Implementing a structured workflow can improve iron repletion rates and patient benefits.
  • Addressing practical challenges ensures eligible patients receive timely and effective IV iron therapy.

Keywords:
Iron deficiencyferric carboxymaltoseheart failureintravenous ironmultidisciplinary approach

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