Key result
Parenteral iron improves functional capacity in iron-deficient heart failure patients independent of hemoglobin levels, but correcting anemia has not consistently improved hard clinical outcomes.
Why the study?
Despite being common and associated with increased morbidity and mortality, a significant knowledge gap remains regarding the management of anemia in heart failure due to conflicting evidence from recent trials.
Do therapies for anemia and iron deficiency improve symptoms and clinical outcomes in patients with heart failure?
Do therapies for anemia and iron deficiency improve symptoms and clinical outcomes in patients with heart failure?
While parenteral iron improves symptoms in iron-deficient heart failure patients, correcting anemia itself has not consistently improved hard clinical outcomes.
BACKGROUND: Anemia affects one-third of heart failure patients and is associated with increased morbidity and mortality. Despite being one of the commonest comorbidities associated with heart failure, there is a significant knowledge gap about management of anemia in the setting of heart failure due to conflicting evidence from recent trials. MAIN BODY: The etiology of anemia in heart failure is multifactorial, with absolute and functional iron deficiency, decreased erythropoietin levels and erythropoietin resistance, inflammatory state and heart failure medications being the important causative factors. Anemia adversely affects the already compromised hemodynamics in heart failure, besides being commonly associated with more comorbidities and more severe disease. Though low hemoglobin levels are associated with poor outcomes, the correction of anemia has not been consistently associated with improved outcomes. Parenteral iron improves the functional capacity in iron deficient heart failure patients, the effects are independent of hemoglobin levels, and also the evidence on hard clinical outcomes is yet to be ascertained. CONCLUSION: Despite all the research, anemia in heart failure remains an enigma. Perhaps, anemia is a marker of severe disease, rather than the cause of poor outcome in these patients. In this review, we discuss the current understanding of anemia in heart failure, its management and the newer therapies being studied.
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Sharma et al. (2021) conducted a review in Heart failure with anemia and iron deficiency. Anemia and iron deficiency management (parenteral iron, ESAs, blood transfusion) was evaluated. Parenteral iron improves functional capacity in iron-deficient heart failure patients independent of hemoglobin levels, but correcting anemia has not consistently improved hard clinical outcomes.
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