Pathophysiology and Treatment Opportunities of Iron Deficiency in Heart Failure: Is There a Need for Further Trials?

Abstract

Purpose of Review Iron deficiency (ID) complicates heart failure (HF) at different stages of the natural history of the disease; however, this frequent comorbidity is still not comprehensively understood and investigated in terms of pathophysiology. Intravenous iron therapy with ferric carboxymaltose (FCM) should be considered to improve the quality of life, exercise capacity, and symptoms in stable HF with ID, as well as to reduce HF hospitalizations in iron-deficient patients stabilized after an episode of acute HF. The therapy with intravenous iron, however, continues to generate important clinical questions for cardiologists. Recent Findings In the current paper, we discuss the class effect concept for intravenous iron formulations beyond FCM, based on the experiences of nephrologists who administer different intravenous iron formulations in advanced chronic kidney disease complicated with ID and anemia. Furthermore, we discuss the neutral effects of oral iron therapy in patients with HF, because there are still some reasons to further explore this route of supplementation. The different definitions of ID applied in HF studies and new doubts regarding possible interactions of intravenous iron with sodium-glucose co-transporter type 2 inhibitors are also emphasized. Summary The experiences of other medical specializations may provide new information on how to optimally replenish iron in patients with HF and ID.

Striving for the ‘perfect’ definition of iron deficiency in heart failure

“…doi: On the other hand, one may emphasize that current 'guideline' definition is not strictly related with our understanding of iron pathophysiology and more importantly may be prone to the bias related with smoldering inflammatory process in HF. 12 As a result, numerous research groups have explored the most accurate definition of ID in HF and its various subpopulations. However, the key question is different and probably more complex than it may seem at first glance: What definition of ID in HF are we really looking for?…”