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Anaemia in chronic heart failure: what constitutes optimal investigation and treatment?
We read with interest the recent supplement on anaemia in heart failure patients.1 Since the publication by Bolger et al.2 on the benefits of intravenous iron therapy in chronic heart failure (CHF), we have been screening for anaemia and iron deficiency in this cohort. We actively treat these patients based on the criteria of a haemoglobin level less than 12 g/dL, already on optimal conventional heart failure therapy, New York Heart Association (NYHA) class II symptoms or worse, and a ferritin of less than 100 μg/L.
We were previously using an intravenous iron sucrose injection (Venofer®), but side effects were not uncommon and, since 2009, we have switched our practice to using intravenous ferric carboxymaltose (Ferinject®) for day case bolus injections. We have treated 23 patients since November 2009. The population age (all numbers quoted as mean ± standard deviation) was 79±7.5 years, 11 of whom are male. All patients included had symptoms suggestive of at least NYHA Class II heart failure. Prior to treatment, the haemoglobin level was 9.9±0.9 g/dL and the ferritin 55±57 μg/L. The levels were 11.5±0.8 g/dL and 179±155 μg/L respectively, at least one month following treatment. No adverse events relating to the treatment were reported. Most patients (16 of 23) reported a subjective improvement in symptoms after intravenous iron therapy, on telephone questioning and review of clinic notes.
To our knowledge, we are one of only a few hospitals in the United Kingdom currently using this strategy, and have utilised our Medical Day Unit to provide intravenous iron therapy in the outpatient setting, whilst also providing ferric carboxymaltose to acute admissions on the ward, once stabilised.
We would recommend active screening for anaemia and the use of intravenous ferric carboxymaltose, which is effective and convenient for these patients and can feasibly be deployed as a strategy in the optimal treatment of CHF patients.
CT2 Medicine Trainee
Cardiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX
Mohammed Shamim Rahman
ST5 Cardiology Trainee
1. Anaemia in chronic heart failure: what constitutes optimal investigation and treatment? Br J Cardiol 2011;18(Suppl 2):s1–s15.
2. Bolger AP, Bartlett FP, Penston HS, et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol 2006;48:1225–7. http://dx.doi.org/10.1016/j.jacc.2006.07.015