Intravenous iron therapy improves exercise capacity and quality of life in heart failure patients with iron deficiency, whereas evidence for clinical benefits with oral iron is lacking.
Does intravenous iron therapy improve symptoms and quality of life compared to oral iron or placebo in patients with chronic heart failure and iron deficiency?
Intravenous iron therapy is preferred over oral iron for treating iron deficiency in heart failure due to superior efficacy in improving symptoms and quality of life, as well as better tolerability.
This article considers the use and modality of iron therapy to treat iron deficiency in patients with heart failure, an aspect of care which has received relatively little attention compared with the wider topic of anaemia management. Iron deficiency affects up to 50% of heart failure patients, and is associated with poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. The European Society of Cardiology Guidelines for heart failure 2012 recommend a diagnostic work-up for iron deficiency in patients with suspected heart failure. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in heart failure due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. I.v. iron sucrose has consistently been shown to improve exercise capacity, cardiac function, symptom severity, and quality of life. Similar findings were observed recently for i.v. ferric carboxymaltose in patients with systolic heart failure and impaired LVEF in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. I.v. iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of iron deficiency in patients with symptomatic heart failure regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using i.v. iron therapy should now be considered.
McDonagh et al. (2015) conducted a review in Iron deficiency in chronic heart failure. Intravenous iron therapy vs. Oral iron therapy was evaluated. Intravenous iron therapy improves exercise capacity and quality of life in heart failure patients with iron deficiency, whereas evidence for clinical benefits with oral iron is lacking.