Iron Deficiency in Heart Failure

Efficacy and safety of intravenous iron therapy

Chan-Keat Kang, Michael Pope (Lead / Corresponding author), Chim Lang, Paul R. Kalra

Research output: Contribution to journalReview article

5 Citations (Scopus)
84 Downloads (Pure)

Abstract

Aim: To discuss the pathophysiology of iron metabolism in chronic heart failure (CHF), the current knowledge of the efficacy of intravenous (IV) iron therapy in patients with CHF and identify points of controversy as well as highlight areas for future research.

Discussion: Iron deficiency is a recognised complication of many chronic conditions. Numerous studies have reported that iron deficiency is highly prevalent in patients with CHF and is associated with exercise intolerance, reduced quality of life, and increased risk of hospitalisation and mortality. Several small studies have demonstrated IV iron to be associated with improvements in symptoms, exercise capacity, quality of life, renal function, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF), and reduction in NT-pro-brain natriuretic peptide (NT-proBNP) in patients with CHF and iron deficiency. Two larger scale trials confirming these results (FAIR-HF and CONFIRM-HF) have led to guideline recommendations that IV iron therapy should be considered in patients with CHF with reduced ejection fraction and iron deficiency (serum ferritin <100μg/L, or ferritin between 100-299μg/L and transferrin saturation <20%) in order to provide symptomatic relief and improve exercise capacity and quality of life.

Conclusion: IV iron therapy improves symptoms, exercise capacity, and quality of life, at least in the short to intermediate time. However, there is still currently no standardised criteria used to define iron deficiency and the underlying mechanism of iron deficiency in CHF remains incompletely. Further work is required to improve the ability to identify iron deficiency in patients with CHF and evaluate the effect of iron repletion on hard end-points including hospitalisation and morality.
Original languageEnglish
Article numbere12301
Pages (from-to)1-8
Number of pages8
JournalCardiovascular Therapeutics
Volume35
Issue number6
Early online date24 Aug 2017
DOIs
Publication statusPublished - 25 Sep 2017

Fingerprint

Iron
Heart Failure
Safety
Therapeutics
Quality of Life
Exercise
Hospitalization
Apoferritins
Aptitude
Brain Natriuretic Peptide
Transferrin
Ferritins
Stroke Volume
Guidelines
Kidney
Mortality

Keywords

  • Heart failure
  • Anaemia
  • Iron deficiency
  • Iron therapy

Cite this

Kang, Chan-Keat ; Pope, Michael ; Lang, Chim ; Kalra, Paul R. / Iron Deficiency in Heart Failure : Efficacy and safety of intravenous iron therapy. In: Cardiovascular Therapeutics. 2017 ; Vol. 35, No. 6. pp. 1-8.
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abstract = "Aim: To discuss the pathophysiology of iron metabolism in chronic heart failure (CHF), the current knowledge of the efficacy of intravenous (IV) iron therapy in patients with CHF and identify points of controversy as well as highlight areas for future research.Discussion: Iron deficiency is a recognised complication of many chronic conditions. Numerous studies have reported that iron deficiency is highly prevalent in patients with CHF and is associated with exercise intolerance, reduced quality of life, and increased risk of hospitalisation and mortality. Several small studies have demonstrated IV iron to be associated with improvements in symptoms, exercise capacity, quality of life, renal function, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF), and reduction in NT-pro-brain natriuretic peptide (NT-proBNP) in patients with CHF and iron deficiency. Two larger scale trials confirming these results (FAIR-HF and CONFIRM-HF) have led to guideline recommendations that IV iron therapy should be considered in patients with CHF with reduced ejection fraction and iron deficiency (serum ferritin <100μg/L, or ferritin between 100-299μg/L and transferrin saturation <20{\%}) in order to provide symptomatic relief and improve exercise capacity and quality of life.Conclusion: IV iron therapy improves symptoms, exercise capacity, and quality of life, at least in the short to intermediate time. However, there is still currently no standardised criteria used to define iron deficiency and the underlying mechanism of iron deficiency in CHF remains incompletely. Further work is required to improve the ability to identify iron deficiency in patients with CHF and evaluate the effect of iron repletion on hard end-points including hospitalisation and morality.",
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Iron Deficiency in Heart Failure : Efficacy and safety of intravenous iron therapy. / Kang, Chan-Keat; Pope, Michael (Lead / Corresponding author); Lang, Chim; Kalra, Paul R.

In: Cardiovascular Therapeutics, Vol. 35, No. 6, e12301, 25.09.2017, p. 1-8.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Iron Deficiency in Heart Failure

T2 - Efficacy and safety of intravenous iron therapy

AU - Kang, Chan-Keat

AU - Pope, Michael

AU - Lang, Chim

AU - Kalra, Paul R.

N1 - Copyright © 1999 - 2017 John Wiley & Sons, Inc. All Rights Reserved.

PY - 2017/9/25

Y1 - 2017/9/25

N2 - Aim: To discuss the pathophysiology of iron metabolism in chronic heart failure (CHF), the current knowledge of the efficacy of intravenous (IV) iron therapy in patients with CHF and identify points of controversy as well as highlight areas for future research.Discussion: Iron deficiency is a recognised complication of many chronic conditions. Numerous studies have reported that iron deficiency is highly prevalent in patients with CHF and is associated with exercise intolerance, reduced quality of life, and increased risk of hospitalisation and mortality. Several small studies have demonstrated IV iron to be associated with improvements in symptoms, exercise capacity, quality of life, renal function, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF), and reduction in NT-pro-brain natriuretic peptide (NT-proBNP) in patients with CHF and iron deficiency. Two larger scale trials confirming these results (FAIR-HF and CONFIRM-HF) have led to guideline recommendations that IV iron therapy should be considered in patients with CHF with reduced ejection fraction and iron deficiency (serum ferritin <100μg/L, or ferritin between 100-299μg/L and transferrin saturation <20%) in order to provide symptomatic relief and improve exercise capacity and quality of life.Conclusion: IV iron therapy improves symptoms, exercise capacity, and quality of life, at least in the short to intermediate time. However, there is still currently no standardised criteria used to define iron deficiency and the underlying mechanism of iron deficiency in CHF remains incompletely. Further work is required to improve the ability to identify iron deficiency in patients with CHF and evaluate the effect of iron repletion on hard end-points including hospitalisation and morality.

AB - Aim: To discuss the pathophysiology of iron metabolism in chronic heart failure (CHF), the current knowledge of the efficacy of intravenous (IV) iron therapy in patients with CHF and identify points of controversy as well as highlight areas for future research.Discussion: Iron deficiency is a recognised complication of many chronic conditions. Numerous studies have reported that iron deficiency is highly prevalent in patients with CHF and is associated with exercise intolerance, reduced quality of life, and increased risk of hospitalisation and mortality. Several small studies have demonstrated IV iron to be associated with improvements in symptoms, exercise capacity, quality of life, renal function, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF), and reduction in NT-pro-brain natriuretic peptide (NT-proBNP) in patients with CHF and iron deficiency. Two larger scale trials confirming these results (FAIR-HF and CONFIRM-HF) have led to guideline recommendations that IV iron therapy should be considered in patients with CHF with reduced ejection fraction and iron deficiency (serum ferritin <100μg/L, or ferritin between 100-299μg/L and transferrin saturation <20%) in order to provide symptomatic relief and improve exercise capacity and quality of life.Conclusion: IV iron therapy improves symptoms, exercise capacity, and quality of life, at least in the short to intermediate time. However, there is still currently no standardised criteria used to define iron deficiency and the underlying mechanism of iron deficiency in CHF remains incompletely. Further work is required to improve the ability to identify iron deficiency in patients with CHF and evaluate the effect of iron repletion on hard end-points including hospitalisation and morality.

KW - Heart failure

KW - Anaemia

KW - Iron deficiency

KW - Iron therapy

U2 - 10.1111/1755-5922.12301

DO - 10.1111/1755-5922.12301

M3 - Review article

VL - 35

SP - 1

EP - 8

JO - Cardiovascular Therapeutics

JF - Cardiovascular Therapeutics

SN - 1755-5914

IS - 6

M1 - e12301

ER -