The importance of intravenous iron therapy in heart failure with reduced ejection fraction

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a very complex clinical syndrome. Evidence based drug therapy is rapidly improving in the field of heart failure, more and more modern drug therapies are available. However, in the complex, multidisciplinary treatment of heart failure, timely diagnosis and treatment of co-morbidities is essential because it is possible to effectively treat them with targeted therapy. Iron deficiency is very common across the spectrum of heart failure. Iron is an essential microelement, it plays important role in many physiological processes, such as energy-producing processes. It is therefore easy to understand that low iron levels can also play a role in heart failure. It has previously been proven that, independent of iron deficiency, it impairs patients functional capacity, performance and quality of life. Several clinical trials have analyzed the practical benefits of intravenous iron supplementation, but the results obtained were not clear. However, based on current research results and a meta-analysis of clinical trials, based on the European heart failure recommendation renewed in 2023, intravenous iron supplementation is recommended in order to reduce symptoms and improve quality of life (IA indication) and should be considered in order to reduce hospital admissions (IIaA indication) in patients with HFrEF and HFmrEF. Intensive research is ongoing on whether the definition of iron deficiency may need to be reconsidered, and instead of ferritin level, the clinical significance of transferrin saturation is preferred.

Keywords

• heart failure
• chronic kidney disease
• pharmacotherapy