A comprehensive literature review has described the importance of treating iron deficiency in patients with heart failure. Authors state that iron deficiency is common, with a prevalence of up to 50%, but is often overlooked in this population. They describe a favourable effect of intravenous iron in this population, and provide an overview of future clinical trials that will explore the benefits of iron deficiency correction on various heart failure parameters.
Chronic heart failure remains a frequent and severe disease with a poor outcome. Comorbidities (for example, diabetes, chronic obstructive pulmonary disease, chronic renal failure and anaemia) can complicate treatment and negatively affect outcomes. Although iron deficiency is now recognised as an important comorbidity, it is often ignored or assessed only in the context of anaemia.
Iron deficiency contributes to cardiac and peripheral muscle dysfunction, and is associated with poor clinical outcomes, independent of haemoglobin level. In a series of placebo-controlled, randomised studies in patients with heart failure and iron deficiency, intravenous iron had a favourable effect on exercise capacity, functional class, left ventricular ejection fraction, renal function and quality of life. In addition, recent European guidelines recommend the monitoring of iron parameters, such as serum ferritin and transferrin saturation, for all patients with heart failure.
The authors explain that, in the last decade, knowledge about the transport, storage and homeostasis of iron has improved dramatically. They suggest that a global management plan for patients with heart failure is necessary, evaluated in terms of quality of life and physical performance, as well as outcome. Ongoing studies of iron therapy in chronic heart failure will address these issues by assessing endpoints that have a direct impact on daily symptoms and exercise capacity. The authors conclude by stating that additional trials are required, especially examining mortality and iron deficiency in this patient population.
The full article is available in the September 2014 issue of Heart. For information on iron deficiency in cardiology, please click here.