Iron Therapy in Patients With Heart Failure and Iron Deficiency

Review of Iron Preparations for Practitioners

Marcin Drozd; Ewa A. Jankowska; Waldemar Banasiak; Piotr Ponikowski


Am J Cardiovasc Drugs. 2017;17(3):183-201. 

In This Article

Clinical Consequences of ID in HF

In patients with HFrEF, ID is associated with impaired aerobic performance, as reflected by lower peak oxygen consumption (VO2), higher ventilatory response to exercise (VE-VCO2 slope),[14,51,59] and lower 6-min walk test (6MWT) distance.[51] Importantly, in patients with HFrEF, the impact of ID on both peak VO2 and VE-VCO2 slope is independent of and much stronger than the effect of anaemia alone.[59] Similar associations were observed in studies on HFpEF. Núñez et al. have shown that in these patients, low TSAT and ferritin correlate with impaired functional capacity as assessed by cardiopulmonary exercise test.[52] Importantly, in one study including both HFrEF and HFpEF patients, the 6MWT distance was also decreased in subjects with versus without ID.[53] The presence of ID is also associated with decreased health-related quality of life (HRQoL), as assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ).[46,60] Further, in both HFrEF and HFpEF, concomitant ID predicts increased long-term all-cause mortality independently of the presence of anaemia[14,23,24,26] or ethnicity.[49] In patients hospitalized for acute HF, ID increases the risk for re-hospitalization within 30 days after discharge,[61] combined all-cause death or non-fatal cardiovascular event (hospitalization for congestive HF, acute coronary syndrome, severe arrhythmia or stroke),[48] and combined death or heart transplantation.[24]