Anemia and iron deficiency in heart failure: extending evidences from chronic to acute setting

Excerpt

Iron deficiency without (ID) or with anemia (IDA) is common and prognostically relevant in patients with heart failure (HF), but most of the evidence derives from chronic heart failure (CHF). In CHF, the prevalence of anemia is 30–50% [1], while ID is found in around 30% and 60% of anemic and non-anemic patients, respectively [1]. Both conditions are independently associated to reduced exercise capacity, poor quality of life, risk of hospitalization, increased all-cause and cardiovascular mortality, and increased costs [1‐5]. Of note, unfavorable outcomes associated with anemia are not prevented by simply correcting Hb levels with blood transfusions or erythropoiesis stimulating agents (ESAs). Rather, blood transfusions are independent risk factor for mortality in HF, and ESAs have been associated to uncertain benefits along with not negligible risk of thrombosis [6]. On the other hand, a large amount of data in patients with CHF and IDA has documented positive effects of intravenous (i.v.) iron repletion with new compounds like ferric carboxymaltose (FCM), which has been evaluated in large RCT, i.e., FAIR-HF, CONFIRM-HF, and EFFECT-HF [7‐9]. …