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Towards Holistic Heart Failure Management—How to Tackle the Iron Deficiency Epidemic?

  • Comorbidities of Heart Failure (C Angermann & F Edelmann, Section Editors)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Heart failure (HF) is a common, costly, disabling, and deadly clinical syndrome and often associated with one or several co-morbidities complicating its treatment or worsening its symptoms. During the last decade, iron deficiency (ID) got recognized as a frequent, debilitating yet easily treatable co-morbidity in HF. In this review, we focus on new evidence that emerged during the last 5 years and discuss the epidemiology, the causes, and the clinical consequences of ID in HF.

Recent Findings

Apart from replenishing iron stores, intravenous iron improves patients’ symptoms, perceived quality of life (QoL), exercise capacity, and hospitalization rates. These beneficial effects cannot be attributed to oral iron, as increased hepcidin levels, typical in inflammatory states such as HF, preclude resorption of iron from the gut.

Summary

Intravenous iron is the only valid treatment option for ID in HF. However, there are several burning research questions and gaps in evidence remaining in this research field.

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Abbreviations

6 MW:

6-min walk

BNP:

Brain natriuretic peptide

CI:

Confidence interval

CRP:

C-reactive protein

CRT:

Cardiac resynchronization therapy

eGFR:

Estimated glomerular filtration rate

FCM:

Ferric carboxymaltose

FU:

Follow-up

Hb:

Hemoglobin

HF:

Heart failure

HFPEF:

Heart failure with preserved ejection fraction

HFREF:

Heart failure with reduced ejection fraction

HR:

Hazard ratio

ID:

Iron deficiency

MLHFQ:

Minnesota Living with Heart Failure Questionnaire

NYHA:

New York Heart Association

PGA:

Patient Global Assessment

QoL:

Quality of life

SAE:

Severe adverse event

TSAT:

Transferrin saturation

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Acknowledgements

LNLVA is supported by a European Society of Cardiology Training Grant (2015) and an International Society for Heart and Lung Transplantation Travel Grant (August 2015 and 2016). LNLVA gratefully acknowledges the financial support from the Fund for Cardiac Surgery through the Jacqueline Bernheim prize 2015.

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg O&N1, Herestraat 49, box 911, 3000, Leuven, Belgium

    Lucas N. L. Van Aelst

  2. Department of Cardiology, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France

    Lucas N. L. Van Aelst & Alain Cohen-Solal

  3. U942 INSERM, Assistance Publique—Hôpitaux de Paris, Paris, France

    Lucas N. L. Van Aelst & Alain Cohen-Solal

  4. Department of Hematology, De Pintelaan 185, 9000, Ghent, Belgium

    Dominiek Mazure

  5. University Paris VII—Denis Diderot, Sorbonne Paris Cité, Paris, France

    Alain Cohen-Solal

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  1. Lucas N. L. Van Aelst
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  2. Dominiek Mazure
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  3. Alain Cohen-Solal
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Correspondence to Alain Cohen-Solal.

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Lucas NL Van Aelst and Dominiek Mazure declare no conflicts of interest. Alain Cohen-Solal is a member of a scientific advisory board of Vifor Pharma.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Comorbidities of Heart Failure

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Van Aelst, L.N.L., Mazure, D. & Cohen-Solal, A. Towards Holistic Heart Failure Management—How to Tackle the Iron Deficiency Epidemic?. Curr Heart Fail Rep 14, 223–234 (2017). https://doi.org/10.1007/s11897-017-0338-8

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