Iron deficiency in chronic heart failure: case-based practical guidance

Abstract

In patients with chronic heart failure, iron deficiency, even in the absence of anaemia, can aggravate the underlying disease and have a negative impact on clinical outcomes and quality of life. The 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure recognize iron deficiency as a co-morbidity in chronic heart failure and recommend iron status screening in all newly diagnosed patients with chronic heart failure. Furthermore, the guidelines specifically recommend considerations of intravenous iron therapy, ferric carboxymaltose, for the treatment of iron deficiency. However, in spite of these recommendations, iron deficiency remains often overlooked and undertreated. This may be due, in part, to the lack of clinical context and practical guidance accompanying the guidelines for the treating physician. Here, we provide practical guidance complemented by a case study to assist and improve the timely diagnosis, treatment, and routine management of iron deficiency in patients with chronic heart failure.

Keywords: Case study; Chronic heart failure; Ferric carboxymaltose; Iron deficiency; Practical guidance.

Figure 1

(A) Diagnostic and (B) treatment algorithms for iron deficiency in patients with chronic heart failure.1 *The use of ferric carboxymaltose has not been studied in children and is therefore not recommended in children under 14 years old. For full prescribing information, please refer to the summary of product characteristics.20 ^†The maximum dose per week of ferric carboxymaltose is 1000 mg. Two dosing sessions are required in case the patient needs >1000 mg ferric carboxymaltose.20 Algorithms adapted from Cappellini et al.1 and McDonagh and Macdougall.7 Hb, haemoglobin; i.v., intravenous; NYHA, New York Heart Association; TSAT, transferrin saturation.

Figure 2

Patient's changes in serum ferritin, transferrin saturation (TSAT), and haemoglobin (Hb) levels over time.