Anemia, erythrocytosis and iron deficiency as prognostic markers of chronic heart failure development

In guidelines of the European Society of Cardiology (ESC) for the diagnosis and treatment of chronic and acute heart failure 2021 authors have written necessity of regular checkup of all patients with chronic heart failure (CHF) to identify anemia or iron deficiency. The prevalence of anemia in patients with CHF varies significantly depending on the clinical characteristics of the studied population and the criteria for the diagnosis of anemia from 4 to 75%. Frequency of iron deficiency without anemia, according to various studies, achieve 55% of cases. In the literature, data are increasingly appearing that even mild anemia and iron deficiency are associated with worsening symptoms, decreased exercise tolerance. They can provoke increasing of numbers of hospitalizations of patients with CHF, and decreasing of their quality of life and increasing rate of mortality. In this paper a number of factors determining iron deficiency in patients with CHF are analyzed. The article also assesses the current state of the problem of the dependence of the presence of anemic syndrome and the gender-age characteristics of patients with CHF, observed in a number of studies, which remains quite contradictory to date. The results of the study of the mechanisms of development of secondary erythrocytosis and the course of CHF against the background of anemic syndrome, iron deficiency conditions, relative erythrocytosis are presented, promising directions of drug correction are reflected. Data from randomized controlled trials (RCTs) on the possibility of using iron supplementation as part of the management of patients with CHF and iron deficiency status are presented. It was noted that using of an injectable form of iron carboxymaltosate in patients with CHF and low EF improves the functional class of CHF according to NYHA, quality of life, tolerance to physical activity, as well as contributes to an increase in the left ventricular ejection fraction and its final systolic volume.