Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice

Abstract

Iron deficiency is common in patients with chronic heart failure (CHF) and is associated with reduced exercise performance, impaired health‐related quality of life and an increased risk of mortality, irrespective of whether or not anaemia is present. Iron deficiency is a serious but treatable condition. Several randomized controlled clinical trials have demonstrated the ability of intravenous (IV) iron, primarily IV ferric carboxymaltose (FCM), to correct iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF), resulting in improvements in exercise performance, CHF symptoms and health‐related quality of life. The importance of addressing the issue of iron deficiency in patients with CHF is reflected in the 2016 European Society of Cardiology (ESC) heart failure guidelines, which recognize iron deficiency as an important co‐morbidity, independent of anaemia. These guidelines recommend that all newly diagnosed heart failure patients are routinely tested for iron deficiency and that IV FCM should be considered as a treatment option in symptomatic patients with HFrEF and iron deficiency (serum ferritin < 100 µg/L, or ferritin 100–299 µg/L and transferrin saturation < 20%). Despite these specific recommendations, there is still a lack of practical, easy‐to‐follow advice on how to diagnose and treat iron deficiency in clinical practice. This article is intended to complement the current 2016 ESC heart failure guidelines by providing practical guidance to all health care professionals relating to the procedures for screening, diagnosis and treatment of iron deficiency in patients with CHF.

Incidence of hypophosphatemia in patients with inflammatory bowel disease treated with ferric carboxymaltose or iron isomaltoside

“…36 Awareness of the benefits of treating iron deficiency and iron deficiency anaemia with high-dose intravenous iron across various medical and surgical conditions is steadily increasing, with improvements reported in patient quality of life and disease outcomes, and reductions in morbidity. [37][38][39] However, the finding in this study of persistent moderate to severe hypophosphatemia beyond 6 weeks after intravenous iron treatment with ferric carboxymaltose is a clinical concern that requires further investigation. In general, monitoring phosphate levels for longer than 6 weeks after administration of intravenous iron may be unnecessary.…”

“…Anaemia is one of the most common extra‐intestinal manifestations in IBD, and one of the most common health‐related problems world‐wide . Awareness of the benefits of treating iron deficiency and iron deficiency anaemia with high‐dose intravenous iron across various medical and surgical conditions is steadily increasing, with improvements reported in patient quality of life and disease outcomes, and reductions in morbidity . However, the finding in this study of persistent moderate to severe hypophosphatemia beyond 6 weeks after intravenous iron treatment with ferric carboxymaltose is a clinical concern that requires further investigation.…”

Highlights in heart failure

“…[58][59][60] Ferric carboxymaltose improves functional capacity, symptoms, and quality of life of HF patients with iron deficiency. 61,62 A meta-analysis of data from the four major randomized controlled trials conducted, to date, demonstrated also a reduction in recurrent CV hospitalizations ( Figure 2). 63 Ongoing trials are aimed at showing the impact of iron therapy on outcomes, including mortality.…”

“…101,102,188,189 The contribution of comorbidities to patients' outcomes may be similar in patients with HFrEF, compared with those with HFpEF, 189 or be larger in those with HFpEF according to other analyses. 60,61,63,201 They were all shown to have a major impact on clinical presentation, response to treatment and outcomes. 60,61,63,201 They were all shown to have a major impact on clinical presentation, response to treatment and outcomes.…”

“…132 The most frequent noncardiac comorbidities include chronic kidney disease, 21,32,134,[190][191][192][193] , chronic obstructive pulmonary disease, 194 central nervous system abnormalities, 195 sleep disordered breathing, 196,197 diabetes mellitus, 65,198,199 cancer, 188,200 and iron deficiency. 60,61,63,201 They were all shown to have a major impact on clinical presentation, response to treatment and outcomes. It is, however, unproven that their specific treatment may be associated with better outcomes.…”