Iron Therapy in Patients with Heart Failure and Iron Deficiency: Review of Iron Preparations for Practitioners

There is an increasing awareness of the prevalence of iron deficiency in patients with heart failure (HF), and its contributory role in the morbidity and mortality of HF. Iron is a trace element necessary for cells due to its capacity to transport oxygen and electrons. The prevalence of iron deficiency increases with the severity of HF. For a long time the influence of iron deficiency was underestimated, especially in terms of worsening of cardiovascular diseases and developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and HF showed new insights into the improvement of iron therapy. Additionally, experimental studies supporting the understanding of iron metabolism and the resulting pathophysiological pathways of iron have been carried out. The aim of this mini review is to highlight why iron deficiency is recognised as an important comorbidity in HF.

Download Full-text

Iron therapy in iron-deficiency patients with heart failure with preserved ejection fraction

Medicine ◽

10.1097/md.0000000000026919 ◽

2021 ◽

Vol 100 (32) ◽

pp. e26919

Author(s):

Hidekatsu Fukuta ◽

Hiromi Hagiwara ◽

Takeshi Kamiya

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Iron Therapy ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure

Download Full-text

Intravenous Iron Infusion With Ferric Carboxymaltose in Patients With Heart Failure and Iron Deficiency

Case Medical Research ◽

10.31525/ct1-nct03871699 ◽

2019 ◽

Author(s):

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Intravenous Iron ◽

Ferric Carboxymaltose ◽

Patients With Heart Failure

Download Full-text

Efficacy, safety and prognostic benefit of intravenous iron therapy with ferric carboxymaltose in patients with heart failure and left ventricular dysfunction

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.08.204 ◽

2016 ◽

Vol 202 ◽

pp. 118-120 ◽

Cited By ~ 6

Author(s):

Ainhoa Robles-Mezcua ◽

Noemí González-Cruces ◽

Amalio Ruiz-Salas ◽

Luis Morcillo-Hidalgo ◽

Juan Robledo-Carmona ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Intravenous Iron ◽

Left Ventricular ◽

Iron Therapy ◽

Ferric Carboxymaltose ◽

Patients With Heart Failure ◽

Intravenous Iron Therapy

Download Full-text

Poor efficacy of oral iron replacement therapy in pediatric patients with heart failure

Cardiology in the Young ◽

10.1017/s1047951121004066 ◽

2021 ◽

pp. 1-8

Author(s):

Kriti Puri ◽

Joseph A. Spinner ◽

Jacquelyn M. Powers ◽

Susan W. Denfield ◽

Hari P. Tunuguntla ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Transferrin Saturation ◽

Systolic Heart Failure ◽

Oral Iron ◽

Wilcoxon Test ◽

Iron Therapy ◽

Oral Iron Therapy ◽

Iron Deficient ◽

Iron Replacement

Abstract Introduction: Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure. Methods: We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and haematologic indices pre- and post-iron therapy were compared using paired-samples Wilcoxon test. Results: Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy. Conclusions: This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.

Download Full-text

Expert consensus regarding treatment of iron deficiency in stable and decompensated patients with heart failure

Kardiologiia ◽

10.18087/cardio.2021.4.n1639 ◽

2021 ◽

Vol 61 (4) ◽

pp. 73-78

Author(s):

Yu. V. Mareev ◽

S. R. Gilarevsky ◽

Yu. L. Begrambekova ◽

Yu. M. Lopatin ◽

A. A. Garganeeva ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ferric Carboxymaltose ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure ◽

High Prevalence ◽

Acute Decompensation

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms. It is, therefore, reasonable to screen for and treat ID in patients with HF.

Download Full-text

Monitoring of iron status in patients with heart failure

European Heart Journal Supplements ◽

10.1093/eurheartj/suz231 ◽

2019 ◽

Vol 21 (Supplement_M) ◽

pp. M32-M35 ◽

Cited By ~ 2

Author(s):

Ewa A Jankowska ◽

Michał Tkaczyszyn ◽

Marcin Drozd ◽

Piotr Ponikowski

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Serum Ferritin Level ◽

Iron Status ◽

Ferritin Level ◽

Transferrin Saturation ◽

Intravenous Iron ◽

Accurate Method ◽

Separate Entity ◽

Patients With Heart Failure

Abstract The 2016 ESC/HFA heart failure (HF) guidelines emphasize the importance of identifying and treating iron deficiency (ID) in patients with HF. Iron deficiency can occur in half or more of HF sufferers, depending on age and the phase of the disease. Iron deficiency can be a cause of anaemia, but it is also common even without anaemia, meaning that ID is a separate entity, which should be screened for within the HF population. Although assessment of iron stores in bone marrow samples is the most accurate method to investigate iron status, it is not practical in most HF patients. Levels of circulating iron biomarkers are an easily available alternative; especially, ferritin and transferrin saturation (Tsat). In patients with HF serum ferritin level <100 µg/L (regardless of Tsat value) or between 100 and 299 µg/L with Tsat <20% are considered as recommended criteria for the diagnosis of ID, criteria which have been used in the clinical trials in HF that have led to a recommendation to treat ID with intravenous iron. We discuss the optimal measures of iron biomarkers in patients with HF in order to screen and monitor iron status and introduce some novel ways to assess iron status.

Download Full-text

Prevalence and pattern of Iron deficiency in patient with heart failure with reduced ejection fraction

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i2.30689 ◽

2019 ◽

Vol 7 (2) ◽

pp. 10-16

Author(s):

Aditya Mahaseth ◽

Jay Narayan Shah ◽

Bikash Nepal ◽

Biplave Karki ◽

Jeet Ghimire ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Functional Iron Deficiency ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Absolute Iron Deficiency

Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia. Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency. Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.

Download Full-text