Iron deficiency as an emerging therapeutic target in patients stabilized after an episode of acute heart failure

Acute heart failure (AHF) syndromes are among the most frequent causes of hospitalization in the elderly and put a heavy financial burden on healthcare systems, mainly due to high early readmission rates. The understanding of AHF has evolved over the years from a significant hemodynamic failure to a multi-organ disease in the course of which peripheral mechanisms such as dysregulated cardiorenal axis or inflammation also play essential roles. A few available observational studies investigating iron deficiency (ID) in patients hospitalized for AHF indicate that this comorbidity is more prevalent than in chronic heart failure, and iron status presents some dynamics in these subjects. ID in AHF predicts increased mortality, greater risk for early readmission and is related to prolonged hospitalization. This paper reviews the results of the first multicenter, double-blind, randomized clinical trial on ferric carboxymaltose in patients who were stabilized after an episode of AHF who had concomitant ID (AFFIRM-AHF), and potential pathophysiological links between dysregulated iron status and AHF syndromes are discussed.