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. 2025 Oct;12(5):3475-3482.
doi: 10.1002/ehf2.15340. Epub 2025 Jun 21.

Implementation of guidelines for intravenous iron therapy in heart failure patients

Milou Gamage  1 , Aristomenis Manouras  1   2   3 , Camilla Hage  1   2   3 , Gianluigi Savarese  1   2   3 , Karin Ljung  1   2   3 , Michael Melin  1   2   4
Affiliations

Implementation of guidelines for intravenous iron therapy in heart failure patients

Milou Gamage et al. ESC Heart Fail. 2025 Oct.

Abstract

Aims: We aim to evaluate the implementation of the 2021 ESC Guidelines regarding screening and treatment of iron deficiency in patients with heart failure (HF) at Karolinska University Hospital.

Methods and results: Patients with left ventricular ejection fraction (LVEF) < 50% and New York Heart Association (NYHA) class II-IV who visited Karolinska University Hospital in 2021 were identified through the registry SwedeHF. Data on patient characteristics, screening for iron deficiency, administration of ferric carboxymaltose (FCM) and HF medication were extracted from patients' health records. There were 261 patients registered whereof 141 (54%) were screened. Screened patients had lower LVEF [33% vs. 36% (P = 0.033)], higher N terminal pro brain natriuretic peptide levels [2880 ng/L vs. 1960 ng/L (P = 0.040)], higher prevalence of diabetes [31.9% vs. 20.0% (P = 0.030)] and were more often prescribed sodium-glucose co-transporter 2 inhibitors (SGLT2i) (49.6% vs. 25.8%) and loop diuretics [76.6% vs. 56.7% (both P < 0.001] compared with unscreened patients. Patients treated with intravenous iron had a higher NYHA class than untreated patients with an indication for treatment (P = 0.038).

Conclusions: In patients with HFrEF and HFmrEF, 54% were screened for iron deficiency. Screened patients had more advanced HF disease, possibly due to increased medical attention and higher compliance to guideline recommended treatment. We demonstrate that national quality registries can track outcomes and effectively enhance patient care.

Keywords: Guidelines; Heart failure; Implementation science; Iron deficiency.

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Conflict of interest statement

Dr. Savarese reports grants and personal fees from Vifor, Boehringer Ingelheim, AstraZeneca, Servier, Novartis, Cytokinetics, Pharmacosmos, and personal fees from Roche, Abbott, Edwards Lifescience, Medtronic, TEVA, INTAS and grants from Boston Scientific, Merck, Bayer, all outside the submitted work. Camilla Hage reports consulting fees from Novartis, Roche Diagnostics and AnaCardio, research grants from Bayer and speaker and honoraria from AstraZeneca and Novartis.

Figures

Figure 1
Figure 1
Flow chart of the study population. The number of patients excluded is given and followed by the reason for exclusion. KS, Karolinska Universitetssjukhuset; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.
Figure 2
Figure 2
Proportion of treated and untreated patients. The number shows the proportion of the patient group that was screened who were treated and untreated. Values are n (%).
Figure 3
Figure 3
Flow chart of the reassessment of unscreened and untreated patients for screening. The number of excluded patients is given and followed by the reason for exclusion. IV, intravenous; KS, Karolinska University Hospital; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.
See this image and copyright information in PMC

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