Iron Deficiency in Heart Failure at a Glance  

Photo Credit: Viktoriya Kabanova

A recent study found that current ID and IDA management in patients with HF falls short of guidelines, highlighting a need for innovative strategies.

In 2019, the American College of Cardiology released fundamentals for physicians to keep in mind for patients with heart failure (HF) with iron deficiency (ID). They included:  

1. High Prevalence: Over 50% of ambulatory heart failure patients have iron deficiency anemia, which is a significant predictor of worse functional capacity and survival. 
2. Risk Factors: Female sex, advanced heart failure, and elevated levels of NT-proBNP and CRP are associated with higher risk of iron deficiency in heart failure patients. 
3. Specific Definition: In heart failure, iron deficiency is defined as ferritin levels below 100 µg/L, or ferritin levels of 100-299 µg/L with transferrin saturation below 20%. 
4. Preferred Treatment: Intravenous (IV) iron, particularly iron sucrose or ferric carboxymaltose, is the preferred treatment for heart failure patients with iron deficiency. 
5. Clinical Trials: IV iron has been shown to improve patient-reported outcomes and functional capacity in heart failure patients with iron deficiency, though its impact on mortality and hospitalizations is still under investigation. 
6. Meta-Analyses: IV iron therapy in heart failure patients is linked to reduced risk of all-cause mortality and cardiovascular hospitalization. 
7. Oral Iron Ineffectiveness: Oral iron has not proven effective in heart failure patients with reduced ejection fraction, and it is associated with high adverse effects and poor absorption. 
8. Guideline Recommendations: European guidelines recommend IV ferric carboxymaltose for symptomatic heart failure patients with iron deficiency, while US guidelines recommend IV iron without specifying a formulation. 
9. Ongoing Research: The role of iron in heart failure patients with preserved ejection fraction is not yet established, but research is ongoing to determine its efficacy.

Coincidentally, a study published online in April 2024 in Circulation: Heart Failure, found “current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations.”  

The study investigated the prevalence and treatment practices of ID and iron deficiency anemia (IDA) among patients with HF in focusing on both acute and chronic cases. Using data from 2012 to 2019 within a large, single-payer healthcare system, the researchers identified adult patients with HF and categorized them as having either acute or chronic HF. Researchers determined HF subtypes through echocardiography and identified ID and IDA through laboratory measurements. The study also assessed the eligibility of these patients for three major clinical trials related to iron therapy in HF.  

The results revealed that iron deficiency is highly prevalent among patients with HF, with 72.6% of patients with acute HF and 73.9% of patients with chronic HF testing positive for ID. Additionally, more than half of these patients had IDA. Despite these high prevalence rates, only about 40% of patients with IDA received iron therapy. Among those with ID but without anemia, less than 22% were prescribed iron therapy, and oral iron supplements were the most common form of treatment. 

The study highlighted a significant gap between current treatment practices and existing guideline recommendations for managing ID and IDA in patients with HF. The authors concluded that there is a need for innovative strategies to improve the investigation and treatment of iron deficiency in this patient population, emphasizing the potential benefits of optimizing iron therapy in HF management. 

The study investigated the prevalence and treatment practices of ID and iron deficiency anemia (IDA) among patients with HF in focusing on both acute and chronic cases. Using data from 2012 to 2019 within a large, single-payer healthcare system, the researchers identified adult patients with HF and categorized them as having either acute or chronic HF. Researchers determined HF subtypes through echocardiography and identified ID and IDA through laboratory measurements. The study also assessed the eligibility of these patients for three major clinical trials related to iron therapy in HF.  

The results revealed that iron deficiency is highly prevalent among patients with HF, with 72.6% of patients with acute HF and 73.9% of patients with chronic HF testing positive for ID. Additionally, more than half of these patients had IDA. Despite these high prevalence rates, only about 40% of patients with IDA received iron therapy. Among those with ID but without anemia, less than 22% were prescribed iron therapy, and oral iron supplements were the most common form of treatment. 

The study highlighted a significant gap between current treatment practices and existing guideline recommendations for managing ID and IDA in patients with HF. The authors concluded that there is a need for innovative strategies to improve the investigation and treatment of iron deficiency in this patient population, emphasizing the potential benefits of optimizing iron therapy in HF management.