Perspectives

The importance of iron deficiency in heart failure

Perspectives

The importance of iron deficiency in heart failure

SEAN M. CONTE, Hannah Kempton, Callum Cherrett, Christopher Hayward

Figures

© LIYA GRAPHICS/SHUTTERSTOCK
© LIYA GRAPHICS/SHUTTERSTOCK

Abstract

Iron deficiency and anaemia are common in patients with heart failure and independently associated with worse outcomes, including higher morbidity and reduced quality of life. All patients with heart failure should be screened for these conditions. If present, anaemia may be managed acutely with a restrictive red blood cell transfusion, whereas intravenous iron supplementation is the standard of care for iron deficiency in this population.

Key Points

  • Iron deficiency (ID), even in the absence of anaemia, in patients with heart failure (HF) is common, multifactorial and associated with worse outcomes.
  • Anaemia should be thoroughly investigated and other common causes including blood loss, nutritional deficiencies and chronic renal failure considered.
  • ID in HF is confirmed with iron studies showing a ferritin level less than 100 mcg/L or a ferritin level 100 to 299 mcg/L with a transferrin saturation below 20%.
  • Oral iron supplementation has not shown consistent benefit in HF cohorts to be recommended in lieu of intravenous (IV) iron.
  • IV iron supplementation in patients with HF and ID has numerous benefits including reduction in HF hospitalisations, reduction in symptoms, improved functional capacity and improved quality of life.