Heart failure module 5: special cases in heart failure

Released1 November 2017     Expires: 01 November 2019      Programme:

The future of iron therapy for patients with heart failure

IV iron is currently recommended by the European Society of Cardiology (ESC) guidelines to alleviate symptoms and improve QoL for patients with heart failure and iron deficiency (ferritin <100 μg/L or <300 μg/L and transferrin saturations <20%).21

Table 4. summarises the recent and ongoing trials of iron in outpatients with heart failure.

Heart failure learning module - Table 4. Recent and ongoing trials of iron in outpatients with heart failure
Table 4. Recent and ongoing trials of iron in outpatients with heart failure

However, caution is required as the primary end points of both FAIR-HF and CONFIRM-HF may have been subject to bias. For example, in FAIR-HF, the proportion of patients in the placebo group who reported any improvement in symptoms (either ‘a little improved’, ‘moderately improved’ or ‘much improved’) was 53% compared to 74% in the IV iron group. This improvement was despite significant differences in ferritin (312 μg/L vs. 74 μg/L, P<0.001) and transferrin saturations (29% vs. 19%, P<0.001) between the groups after 24 weeks of treatment. The possibility of a placebo effect cannot be ignored.

Similarly, the absolute improvement in 6MWT distance for patients treated with IV iron in CONFIRM-HF after 24 weeks was 18 metres. The 6MWT is prone to a ‘learning effect’ and such a small change in distance may not be purely due to treatment.

Peak VO2 is the ‘gold-standard’ measure of exercise capacity in patients with heart failure but was unchanged after 16 weeks of treatment with oral iron in the IRONOUT study. It was not studied in FAIR-HF or CONFIRM-HF and is not defined as a primary or secondary outcome for the IRONMAN study. Whether or not IV iron improves exercise capacity in patients with heart failure as measured by peak VO2 will remain unsettled. Meanwhile, IV iron is given for symptomatic relief and the results of the IRONMAN trial are eagerly awaited.

Summary statement

Electrolyte abnormalities, anaemia and iron deficiency are common complications of heart failure and its treatment. All have negative effects on prognosis and are potential therapeutic targets. However, whether or not correction of the abnormality translates into improved outcomes is unproven.

close window and return to take test


1. Ahmed M, Ekundayo O, Mujib M, et al. Mild hyperkalemia and outcomes in chronic heart failure: a propensity matched study. Int. J. Cardiol. 2010;144:383–8. https://doi.org/10.1016/j.ijcard.2009.04.041

2. Gheorghiade M, Rossi J, Cotts W, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the escape trial. Arch Intern Med 2007;167:1998–2005. https://doi.org/10.1001/archinte.167.18.1998

3. Cooper L, Mentz R, Gallup D, et al. Serum bicarbonate in acute heart failure: relationship to treatment strategies and clinical outcomes. J Card Fail 2016;22(9):738-42. https://doi.org/10.1016/j.cardfail.2016.01.007

4. Krogager ML, Eggers-Kaas L, Aasbjerg K et al. Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction. Eur Heart J Cardiovasc Pharmacother 2015;1(4):245-51. https://doi.org/10.1093/ehjcvp/pvv026

5. Hoss S, Elizur Y, Luria D, Keren A, Lotan C, Gotsman I. Serum Potassium Levels and Outcome in Patients With Chronic Heart Failure. Am J Cardiol 2016;118(12):1868–74. https://doi.org/10.1016/j.amjcard.2016.08.078

6. Ter Maaten JM, Damman K, Hanberg JS et al. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circ Heart Fail 2016;9(8):e003109. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003109

7. Testani JM, Hanberg JS, Arroyo JP et al. Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure. Eur J Heart Fail 2016;18(6):660–8. https://doi.org/10.1002/ejhf.477

8. Urso C, Brucculeri S, Caimi G. Acid-base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev 2015;20(4):493–503. https://doi.org/10.1007/s10741-015-9482-y

9. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 8: advanced challenges in resuscitation: section 1: life-threatening electrolyte abnormalities. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation 2000;102(8 Suppl):I217–22. https://doi.org/10.1161/01.CIR.102.suppl_1.I-86

10. Crespo-Liero MG, Anker SD, Maggioni AP et al. European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail 2016;18:613–25 https://doi.org/10.1002/ejhf.566

11. Nicholas R, Banner NR, Bonser RS, Clark AL et al. UK guidelines for referral and assessment of adults for heart transplantation. Heart 2011;97:1520–7. https://doi.org/10.1136/heartjnl-2011-300048

12. Verbrugge FH, Steels P, Grieten L, Nijst P, Tang WH, Mullens W. Hyponatremia in acute decompensated heart failure: depletion versus dilution. J Am Coll Cardiol 2015;65(5):480-92. https://doi.org/10.1016/j.jacc.2014.12.010

13. Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med 2006;119(7 Suppl 1):S47–53. https://doi.org/10.1016/j.amjmed.2006.05.007

14. Schrier RW, Berl T. Nonosmolar factors affecting renal water excretion (first of two parts). N Engl J Med 1975;292(2):81-8. https://doi.org/10.1056/NEJM197501092920207

15. Felker GM, O’Connor CM, Braunwald E. Loop diuretics in acute decompensated heart failure: A necessary evil? Circ Heart Fail 2009;2(1):56-62. 

16. F.H. Verbrugge, M. Dupont, P. Steels, et al. The kidney in congestive heart failure: ‘are natriuresis, sodium, and diuretics really the good, the bad and the ugly?’ Eur J Heart Fail 2014:16;133–42.

17. Donkor A, Cleland JFG, McDonagh T et al. The National Heart Failure Audit April 2014 – March 2015 (2016). Available from: https://www.ucl.ac.uk/nicor/audits/heartfailure/documents/annualreports/heartfailurepublication14_15 [Accessed 10 May 2017].

18. Klein L, O’Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005;111(19):2454–60. https://doi.org/10.1161/01.CIR.0000165065.82609.3D

19. Rusinaru D, Tribouilloy C, Berry C et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta-analysis: Meta-Analysis Global Group in Chronic heart failure (MAGGIC). Eur J. Heart Fail 2012;14(10):1139–46. https://doi.org/10.1093/eurjhf/hfs099

20. De Vecchis R, Di Maio M, Di Biase G, Ariano C. Effects of Hyponatremia Normalization on the Short-Term Mortality and Rehospitalizations in Patients with Recent Acute Decompensated Heart Failure: A Retrospective Study. J Clin Med 2016;5(10).pii:E92. https://dx.doi.org/10.3390%2Fjcm5100092

21. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016;18:891–975. https://doi.org/10.1002/ejhf.592

22. Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern Med 2013;173:1058-64 https://doi.org/10.1001/jamainternmed.2013.552

23. Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci 2008;114:221-30 https://doi.org/10.1042/CS20070193

24. Licata G, Di Pasquale P, Parrinello G, Cardinale A, Scandurra A, Follone G, Argano C, Tuttolomondo A, Paterna S. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J 2003;145:459-66 http://dx.doi.org/10.1067/mhj.2003.166

25. Paterna S, Di Pasquale P, Parrinello G, Fornaciari E, Di Gaudio F, Fasullo S, Giammanco M, Sarullo FM, Licata G. Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: a double-blind study. J Am Coll Cardiol 2005;45:1997-2003 https://doi.org/10.1016/j.jacc.2005.01.059

26. Okuhara Y, Hirotani S, Naito Y, Nakabo A, Iwasaku T, Eguchi A, Morisawa D, Ando T, Sawada H, Manabe E, Masuyama T. Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure. J Card Fail 2014;20(5):295–301. https://doi.org/10.1016/j.cardfail.2014.01.012

27. Gheorghiade M, Konstam M, Grinfeld L et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the Everest clinical status trials. JAMA 2007;297:1332-43. https://doi.org/10.1001/jama.297.12.1332

28. Gheorghiade M, Gottlieb S, Udelson J, et al. Vasopressin V(2) receptor blockade with tolvaptan versus fluid restriction in the treatment of hyponatremia. Am J Cardiol 2006;97:1064–7. https://doi.org/10.1016/j.amjcard.2005.10.050

29. Konstam MA, Gheorghiade M, Burnett JC Jr et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 2007;297(12):1319-31. https://doi.org/10.1001/jama.297.12.1319

30. Grodin JL, Simon J, Hachamovitch R et al. Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure. J Am Coll Cardiol 2015;66(6):659-66. https://doi.org/10.1016/j.jacc.2015.06.007

31. Grodin JL, Verbrugge FH, Ellis SG, Mullens W, Testani JM, Tang WH. Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure. Circ Heart Fail 2016;9(1):e002453. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002453

32. Ter Maaten JM, Damman K, Hanberg JS et al. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circ Heart Fail 2016;9(8):e003109. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003109

33. Hanberg JS, Rao V, Ter Maaten JM et al. Hypochloremia and Diuretic Resistance in Heart Failure: Mechanistic Insights. Circ Heart Fail 2016;9(8):e003180. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003180

34. Schulman M, Narins RG. Hypokalemia and cardiovascular disease. Am J Cardiol. 1990;65:4E–9E; discussion 22E.

35. Weiss JN, Qu Z, Shivkumar K. Electrophysiology of Hypokalemia and Hyperkalemia. Circ Arrhythm Electrophysiol. 2017; 10(3). pii: e004667. https://doi.org/10.1161/CIRCEP.116.004667

36. Pezhouman A, Singh N, Song Z, et al. Molecular basis of hypokalemia-induced ventricular fibrillation. Circulation. 2015;132:1528–37. https://doi.org/10.1161/CIRCULATIONAHA.115.016217

37. Rabelink TJ, Koomans HA, Hené RJ, et al. Early and late adjustment to potassium loading in humans. Kidney Int. 1990;38:942–7. https://doi.org/10.1038/ki.1990.295

38. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med 2004;351:585–92. https://doi.org/10.1056/NEJMra035279

39. Reardon LC, Macpherson DS. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry? Arch Intern Med 1998;158:26–32. https://doi.org/10.1001/archinte.158.1.26

40. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 2010;5(3):531-48. https://doi.org/10.2215/CJN.07821109

41. SOLVD Investigators, Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325(5):293-302. https://doi.org/10.1056/NEJM199108013250501

42. McMurray JJV, Östergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:767–71. https://doi.org/10.1016/S0140-6736(03)14283-3

43. Pitt B, Zannad F, Remme WJ, et al. for the Randomized Aldactone Evaluation Study Investigators. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999;341:709–17. https://doi.org/10.1056/NEJM199909023411001

44. Zannad F, McMurray JJ, Krum H et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011;364(1):11-21. https://doi.org/10.1056/NEJMoa1009492

45. Maggioni AP, Anker SD, Dahlstrom U et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 2013;15(10):1173-84. https://doi.org/10.1093/eurjhf/hft134

46. Vardeny O, Claggett B, Anand I, et al. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist. Circ Heart Fail 2014;7(4):573-9. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001104

47. Rossignol P, Dobre D, McMurray JJ, et al. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circ Heart Fail 2014;7(1):51-8. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000792

48. Vukadinović D, Lavall D, Vukadinović AN, Pitt B, Wagenpfeil S, Böhm M. True rate of mineralocorticoid receptor antagonists-related hyperkalemia in placebo-controlled trials: A meta-analysis. Am Heart J 2017;188:99-108. https://doi.org/10.1016/j.ahj.2017.03.011

49. Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2).
ISSN 2002-4436. Public Domain. https://doi.org/10.15347/wjm/2014.008

50. Yildirim T, AriciM, Piskinpasa S, et al. Major barriers against renin-angiotensin-aldosterone system blocker use in chronic kidney disease stages 3-5 in clinical practice: a safety concern? Ren Fail. 2012;34(9):1095–9. https://doi.org/10.3109/0886022X.2012.717478

51. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med 2013;126:264.e9–24. https://doi.org/10.1016/j.amjmed.2012.08.016

52. DeFilippis EM, Desai AS. Treatment of Hyperkalemia in Heart Failure. Curr Heart Fail Rep 2017 doi: 10.1007/s11897-017-0341-0. [Epub ahead of print]

53. Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ; PEARL-HF Investigators. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 2011:32(7);820-8 https://doi.org/10.1093/eurheartj/ehq502

54. Anker SD, Kosiborod M, Zannad F et al. Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS-9) in heart failure patients: results from a phase 3 randomized, double-blind, placebo-controlled trial. Eur J Heart Fail 2015;17(10):1050-6. https://doi.org/10.1002/ejhf.300

55. Kosiborod M, Peacock WF, Packham DK. Sodium zirconium cyclosilicate for urgent therapy of severe hyperkalemia. N Engl J Med 2015;372(16):1577-8. https://doi.org/10.1056/NEJMc1500353

56. Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E. Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003:42(4);705-8. https://doi.org/10.1016/S0735-1097(03)00765-4

57. O’Meara E, Rouleau JL, White M et al. Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Heart Fail 2014;7:773–81. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001100

58. Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013;34(11):816–29. https://doi.org/10.1093/eurheartj/ehs224

59. Cleland JG, Zhang J, Pellicori P et al. Prevalence and Outcomes of Anemia and Hematinic Deficiencies in Patients With Chronic Heart Failure. JAMA Cardiol 2016;1(5):539-47. https://doi.org/10.1001/jamacardio.2016.1161

60. Isakov E, Froom P, Henig C, Barak M. Anemia and estimated glomerular filtration rates. Ann Clin Lab Sci 2014;44(4):419-24. http://www.annclinlabsci.org/content/44/4/419.long

61. Ishani A, Weinhandl E, Zhao Z, et al. Angiotensin-converting enzyme inhibitors as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2005;45:391–9. https://doi.org/10.1016/j.jacc.2004.10.038

62. M. Mrug, T. Stopka, B.A. Julian, J.F. Prchal, J.T. Prchal. Angiotensin II stimulates proliferation of normal early erythroid progenitors. J Clin Invest 1997:100;2310-4. https://dx.doi.org/10.1172%2FJCI119769

63. Van der Meer P, Lipsic E, Westenbrink BD, et al. Levels of hematopoiesis inhibitor N-acetyl-seryl-aspartyl-lysyl-proline partially explain the occurrence of anemia in heart failure. Circulation 2005;112:1743–7. https://doi.org/10.1161/CIRCULATIONAHA.105.549121

64. Androne AS, Katz SD, Lund L, LaManca J, Hudaihed A, Hryniewicz K, Mancini DM. Hemodilution is common in patients with advanced heart failure. Circulation 2003;107(2):226-9. https://doi.org/10.1161/01.CIR.0000052623.16194.80

65. Westenbrink BD, Visser FW, Voors AA et al. Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J 2007;28(2):166-71. https://doi.org/10.1093/eurheartj/ehl419

66. Fildes JE, Shaw SM, Yonan N, Williams SG. The immune system and chronic heart failure: is the heart in control? J Am Coll Cardiol 2009;53:1013–20. https://doi.org/10.1016/j.jacc.2008.11.046

67. Rauchhaus M, Doehner W, Francis DP et al. Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation 2000;102(25):3060-7. https://doi.org/10.1161/01.CIR.102.25.3060

68. Ferrucci L, Guralnik JM, Woodman RC, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med 2005;118:1288. https://doi.org/10.1016/j.amjmed.2005.06.039

69. Deicher R, Horl WH. Hepcidin: a molecular link between inflammation and anaemia. Dial Transplant 2004;19:521–4. https://doi.org/10.1093/ndt/gfg560

70. van der Wal HH, Comin-Colet J, Klip IT et al. Vitamin B12 and folate deficiency in chronic heart failure. Heart 2015;101(4):302-10. http://dx.doi.org/10.1136/heartjnl-2014-306022

71. Opasich C, Cazzola M, Scelsi L, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 2005;26:2232-7. https://doi.org/10.1093/eurheartj/ehi388

72. Nanas JN, Matsouka C, Karageorgopoulos D, et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006;48:2485-9 https://doi.org/10.1016/j.jacc.2006.08.034

73. Pozzo J, Fournier P, Delmas C, et al. Absolute iron deficiency without anaemia in patients with chronic systolic heart failure is associated with poorer functional capacity. Arch Cardiovasc Dis 2017;110(2):99-105. https://doi.org/10.1016/j.acvd.2016.06.003

74. van Veldhuisen DJ, Dickstein K, Cohen-Solal A, et al. Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia. Eur Heart J 2007;28:2208-16. https://doi.org/10.1093/eurheartj/ehm328

75. Okonko DO, Grzeslo A, Witkowski T, et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008;51:103-12. https://doi.org/10.1016/j.jacc.2007.09.036

76. Silverberg DS, Wexler D, Sheps D et al. The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol 2001;37(7):1775-80. https://doi.org/10.1016/S0735-1097(01)01248-7

77. Swedberg K, Young JB, Anand IS et al. Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med 2013;368(13):1210-9. https://doi.org/10.1056/NEJMoa1214865

78. Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085-98. https://doi.org/10.1056/NEJMoa065485

79. Kasiske BL, Wheeler DC. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease 2012. Available from http://kdigo.org/clinical_practice_guidelines/pdf/KDIGO-Anemia%20GL.pdf [accessed 15 June 2017]

80. Anker SD, Comin Colet J, Filippatos G et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009;361(25):2436-48. https://doi.org/10.1056/NEJMoa0908355

81. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 2015;36(11):657-68. https://doi.org/10.1093/eurheartj/ehu385

82. Ingle L, Sloan R, Carroll S, Goode K, Cleland JG, Clark AL. Influence of body mass on risk prediction during cardiopulmonary exercise testing in patients with chronic heart failure. Exp Clin Cardiol 2012;17(4):179-82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627270/

83. Filippatos G, Farmakis D, Colet JC et al. Intravenous ferric carboxymaltose in iron-deficient chronic heart failure patients with and without anaemia: a subanalysis of the FAIR-HF trial. Eur J Heart Fail 2013;15(11):1267-76. https://doi.org/10.1093/eurjhf/hft099

84. Anker SD, Kirwan BA, van Veldhuisen DJ et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 2017. doi: 10.1002/ejhf.823. [Epub ahead of print]

close window and return to take test


All rights reserved. No part of this programme may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers, Medinews (Cardiology) Limited.

It shall not, by way of trade or otherwise, be lent, re-sold, hired or otherwise circulated without the publisher’s prior consent.

Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs becomes necessary. The editors/authors/contributors and the publishers have taken care to ensure that the information given in this text is accurate and up to date. Readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with the latest legislation and standards of practice.

Healthcare professionals should consult up-to-date Prescribing Information and the full Summary of Product Characteristics available from the manufacturers before prescribing any product. Medinews (Cardiology) Limited cannot accept responsibility for any errors in prescribing which may occur.