Ironing out the details: a comprehensive review of iron therapy in heart failure

Iron deficiency (ID) is common in patients with heart failure (HF) and is independently associated with poor outcomes, such as reduced functional capacity and quality of life, increased frailty and increased risk of HF hospitalisations and mortality. Intravenous iron has been shown to be an effective and well-tolerated therapy in patients with HF with reduced and mildly reduced ejection fraction and ID, improving quality of life and functional status and reducing the risk of HF hospitalisations. This review aims to summarise the evidence behind intravenous iron therapy in HF from recent key randomised-controlled trials. This review will also discuss the evidence for intravenous iron therapy in patients with HF with preserved ejection fraction. Ultimately, we also aim to review remaining uncertainties, such as sex-specific differences in outcomes, the optimal iron repletion and maintenance strategies, and the most accurate measures of ID in HF.