Multidisciplinary approach to implementing ferric carboxymaltose for IV iron replacement in heart failure with iron deficiency

Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF). Treatment with intravenous (IV) iron is recommended by the ACC/AHA/HFSA and ESC guidelines to improve HF symptoms, exercise capacity, and quality of life, and to reduce the risk of hospitalization. Ferric carboxymaltose (FCM) is indicated for ID in adults with HF (NYHA class II/III) to improve exercise capacity. There are challenges in ensuring that eligible patients with HF and ID achieve iron repletion and associated optimal outcomes in routine practice. These challenges include inpatient formulary restrictions which only allow for low-dose IV irons and care transitions when the course of IV iron treatment spans the inpatient and outpatient setting. Despite the ease of administration as a single rapid infusion of up to 1000 mg of iron, inpatient and outpatient formularies do not always include FCM. This guide shares a general workflow used at university-based and private hospital systems, to facilitate routine iron assessment and IV iron repletion in a typical HF care pathway. Perspectives from the cardiologist, nurse, advanced practice provider (APP), and pharmacist roles provide a comprehensive view and emphasize the importance of a multidisciplinary, collaborative approach to optimize outcomes for patients with HF and ID.