Abstract

ROCHA, Bruno M.L.; CUNHA, Gonçalo J.L.  and  FALCAO, Luiz Menezes. Iron Deficiency in Heart Failure: A Rational Approach. Medicina Interna [online]. 2019, vol.26, n.2, pp.141-146. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/Revisao/125/18/2/2019.

Heart failure (HF) is an epidemic syndrome of the 21st century, most often recognized in the elderly. The natural history of chronic HF is characterized by its considerable symptomatic burden and recurrent acute decompensation leading to repeated hospitalizations. Thus, HF is the main cause of hospital admission and rehospitalizations, which translates into markedly high costs. Accordingly, in order to improve individual outcomes and maintain the sustainability of the healthcare system, it is fundamental to adequately treat HF and its common comorbidities. Recently, iron deficiency (ID) has been recognized in over 30% of HF patients, indicating a more severe symptomatic burden, morbidity and mortality rates, constituting a novel therapeutic target. Given the relevance of ID in HF, we ought to: 1. Briefly discuss the main findings of trials comparing iron to placebo or control, namely the inefficacy of oral iron (IRONOUT HF) contrasting to the benefits of intravenous (IV) iron, which led to significant symptomatic improvement and potentially reduced hospitalizations due to worsening HF, as demonstrated in the main ferric carboxymaltose trials (FAIR-HF, CONFIRM-HF, EFFECT-HF); 2. Propose a comprehensive rational algorithmic approach to ID in adequately selected HF patients; 3. Emphasize the selection of candidates for IV iron based on left ventricular ejection fraction, symptoms and haemoglobin concentration; and 4. Review the main adverse effects of IV iron and current gaps in knowledge. An algorithmic approach to ID in HF as an evidence-based intervention may result in optimal therapy for selected patients, as well as decreased IV iron in inadequate scenarios.

Keywords : Anemia; Iron-Deficiency; Ferric Compounds; Heart Failure.

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