Diagnosis and treatment of iron deficiency in chronic heart failure : Position statement of the heart failure working group of the Austrian Society of Cardiology

Abstract

Iron deficiency (ID) is a common comorbidity in heart failure (HF), affecting 55% of chronic and up to 80% of acute HF patients, regardless of ejection fraction (EF). An ID is associated with reduced quality of life, impaired exercise capacity (VO₂ peak), higher hospitalization rate and lower survival rate. It is also an independent predictor of HF outcomes. This consensus statement critically reviews the diagnostic criteria for ID in HF and provides recommendations for their use. The efficacy and safety of intravenous iron supplements, including ferric carboxymaltose (FCM) and ferric derisomaltose (FDI), are analyzed highlighting the indications and potential adverse effects. Key clinical trials and guideline recommendations are summarized. In summary, the document addresses the diagnostics, treatment and monitoring of ID in HF.

Keywords: Austrian consensus statement; Heart failure; Iron carboxymaltose; Iron deficiency; Iron derisomaltose; Iron supplementation.

Fig. 1

Chronological overview of major trials (with year of publication) and ongoing trials (with expected year of publication, green timeline) evaluating the effects of iron deficiency treatment in heart failure. Trials with ferric derisomaltose are marked in red, those with ferric carboxymaltose in blue. FAIR-HF Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency; CONFIRM-HF Ferric Carboxymaltose evaluation on performance in patients with Iron deficiency in combination with chronic Heart Failure; EFFECT-HF Effect of Ferric Carboxymaltose on Exercise Capacity in Patients With Chronic Heart Failure and Iron Deficiency; FERRIC-HF II Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency; AFFIRM-AHF Ferric carboxymaltose for iron deficiency at discharge after acute heart failure; IRONMAN:Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK; HEART-FID Ferric Carboxymaltose in Heart Failure with Iron Deficiency; FAIR-HFpEF Ferric carboxymaltose and exercise capacity in heart failure with preserved ejection fraction and iron deficiency; FAIR-HF2 Intravenous iron in patients with systolic heart failure and iron deficiency to improve morbidity and mortality; IRON-MET HFpEF Impact of Intravenous Iron Repletion On Mechanisms of Exercise InTolerance in HFpEF; COREVIVE HFpEF The Effects of Ferric Derisomaltose in Patients with Acute Heart Failure and Iron Deficiency on Exercise Capacity and Quality of Life; INFERRCT Effect of Intravenous Ferric Carboxymaltose Onmortality and Cardiovascular Morbidity, and Quality of Life in Iron Deficient Patients With Recent Myocardial infarction

Fig. 2

Recommended management of iron deficiency in heart failure. EF Ejection Fraction, FCM Ferric Carboxymaltose, FID Ferric Isomaltose, Hb Hemoglobin, HF Heart Failure, IV Intravenous, NYHA New York Heart Association, TSAT Transferrin Saturation