Date Published: 
Tuesday, 28 May, 2013

Treating iron deficiency in cardiac patients

Treatment for iron deficiency in patients with heart disease (of any type) is often complex, due to multiple co-morbidities and concomitant therapies. The ultimate aim is to restore healthy iron metabolism and turnover in patients with heart disease to improve morbidity, mortality and quality of life1.

Intravenous iron therapy

A number of studies with intravenous iron have shown promising results for the treatment of iron deficiency in patients with heart failure2-6. Iron therapy has been associated with improvements in exercise capacity, fatigue score, NYHA score, haemoglobin level and quality of life.

While iron deficiency is seen in many patients with chronic heart failure, iron overload or increased iron stores are very rare (1%)7. This makes intravenous iron therapy an attractive option for this patient population. In 2009, the FAIR-HF trial reported that 50% of chronic heart failure patients with NYHA class II or III and iron deficiency with or without anaemia (ferritin level <100 μg/L or between 100 and 299 μg/L with transferrin saturation <20%) experienced a much or moderate improvement in symptoms following treatment with IV iron, versus 28% who received placebo. The study also reported an acceptable side effect profile for IV iron, with rates of death, adverse events and serious adverse events the same between the two groups2.

European Society of Cardiology Guidelines

The 2012 update to the European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure recommends the use of intravenous iron therapy in correcting iron deficiency in patients with heart failure2,8, and reports improvements in self-reported patient global assessment and NYHA class, 6-minute walking distance and health-related quality of life following treatment with intravenous iron2.

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