Iron Deficiency Management in Heart Failure Patients
Summary
Iron deficiency is a prevalent comorbidity in heart failure, affecting up to half of patients irrespective of anaemia. Deficiency of iron impairs mitochondrial function in cardiac and skeletal muscle, reduces exercise tolerance and quality of life, and increases rates of hospitalisation. Contemporary management focuses on accurate diagnosis through biomarkers such as serum ferritin and transferrin saturation, and on timely restoration of iron stores, primarily via intravenous preparations. Evidence has demonstrated that targeted iron repletion improves functional capacity, alleviates symptoms, and reduces heart failure hospitalisations. Treatment algorithms now recommend systematic screening at diagnosis of heart failure, incorporating iron studies alongside natriuretic peptides and ejection fraction assessment. Intravenous iron formulations with high-dose, low-frequency regimens have gained favour for their rapid replenishment, favourable safety profile and patient convenience. Integration of iron management into heart failure care pathways holds promise for reducing healthcare burden and improving outcomes globally.
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Iron Deficiency Management in Heart Failure Patients publication trend
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Technical terms
Iron deficiency: A state of insufficient iron to meet physiological demands, often defined by low serum ferritin or transferrin saturation.
Transferrin saturation (TSAT): The percentage of iron-binding sites on transferrin that are occupied by iron; a key measure of circulating bioavailable iron.
Serum ferritin: The principal intracellular iron storage protein; levels reflect total iron reserves and help to distinguish absolute from functional deficiency.
Intravenous iron: Administration of iron compounds directly into the bloodstream, enabling rapid replenishment of iron stores bypassing gastrointestinal absorption.
Left ventricular ejection fraction (LVEF): The proportion of blood ejected from the left ventricle with each heartbeat; a measure of systolic function in heart failure.
References
- Intravenous iron in patients with heart failure and iron deficiency: an updated meta‐analysis. European Journal of Heart Failure (2023).
- Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial. The Lancet (2022).
- Criteria for Iron Deficiency in Patients With Heart Failure. Journal of the American College of Cardiology (2022).
- Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. Journal of Clinical Medicine (2021).
- Iron deficiency in chronic heart failure: case‐based practical guidance. ESC Heart Failure (2018).
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