Cardiology

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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.

Administering iron therapy to symptomatic, iron deficient patients with heart failure, over a one-year period, may result in sustainable improvement in functional capacity and symptoms, and may be associated with reduced hospitalisation. Authors of a new study state that, by targeting the iron deficiency in these patients overall quality of life (QoL) can be improved.

Cohen-Solal and colleagues have recently published an expert position paper from French cardiologists on the diagnosis and treatment of iron deficiency in patients with heart failure. This adds to the increasing literature, including clinical practice guidelines, and opinions expressed by cardiologists, on the possible benefits of correcting iron deficiency in heart failure, following on from Australian and European guidelines1,2.

The recent article by Viethen and colleagues examines the potential role of intravenous iron in a clinical scenario that has not been widely studied, but which has previously yielded some positive data. It builds on a previous publication by Smith and colleagues1 that intravenous iron may be of potential benefit in pulmonary arterial hypertension (PAH).

Iron deficiency is an important pathogenic factor affecting the severity and progression of chronic heart failure. Until now, iron deficiency diagnosis was based on the assessment of transferrin saturation and serum ferritin. Unfortunately, these standard measures of iron status are unreliable in the acute clinical settings (such as in acute heart failure)1.

Commonalities in the typical symptoms of iron deficiency and heart failure mean clinical presentation is of low diagnostic value in these patients. A thorough screening of blood iron status – including measures of storage, circulating and functional iron – are required to accurately diagnose iron deficiency and should be routine practice in this patient population.

Table 2. The commonalities between symptoms of heart failure (HF) and iron deficiency (ID) and iron deficiency anaemia (IDA)1,2

New evidence has revealed that iron deficiency is associated with unfavourable haemodynamics and worsening of New York Heart Assocation (NYHA) functional class in patients with idiopathic pulmonary arterial hypertension (IPAH), indicating that treatment of iron deficiency should be considered in these patients.

There is a significant association between prior iron deficiency anaemia and ischaemic stroke, data indicate. Researchers recommend that patients found to have iron deficiency anaemia be surveyed and managed for the possible underlying bleeding source and/or iron deficiency status in order to reduce the risk of subsequent ischaemic stroke. The authors recommend that the casual relationship between iron deficiency anaemia and ischaemic stroke be further investigated.

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