2021, Volume 28, Supplement 1: Iron deficiency in heart failure

Iron deficiency in heart failure: Introduction

February 2021

Iron deficiency in heart failure: Introduction

Iain Squire

Abstract

This supplement marks 10 years of experience with intravenous irons in the treatment of iron deficiency in heart failure. It reviews and discusses: - the epidemiology, mechanisms and guidelines for treatment of iron deficiency in heart failure - the treatment of iron deficiency in UK patients with heart failure and how to set up an intravenous (IV) iron therapy service - iron therapies, particularly the latest IV irons, including their efficacy, tolerability, side effects and differences - the patient’s experience showing the beneficial effects of IV irons on quality of life and symptoms. ...

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Prevalence, causes, diagnosis and guidelines for treatment

February 2021 Br J Cardiol 2021;28(suppl 1):S3–S6

Prevalence, causes, diagnosis and guidelines for treatment

Mohamed Eltayeb, Vishnu Ashok, Iain Squire

Abstract

Latest international guidelines recommend treatment of iron deficiency in the context of heart failure with reduced ejection fraction. In this review, we discuss iron metabolism and the pathophysiology of iron deficiency, its prevalence and sequelae in patients with heart failure. We will take a look at the evidence behind iron therapy in heart failure with an overview of existing management guidelines. A picture of what should be put in practice will be presented with a look at ongoing and planned research in this field....

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February 2021 Br J Cardiol 2021;28(suppl 1):S7–S9

United Kingdom treatment of iron deficiency in heart failure: are we missing opportunities?

Chun Shing Kwok, Sarah McDermott, Sadie Bennett, Simon Duckett

Abstract

Iron deficiency in patients with reduced ejection fraction heart failure is common. Restoration of iron levels has been shown to improve quality of life, exercise tolerance and reduce hospitalisations. Oral iron therapy has been shown not to improve iron stores. Using intravenous iron improves iron stores, however, there is disparity in guidelines, with no mention within the National Institute of Health and Care Excellence guidelines, while the European Society Cardiology guidance recommends consideration of treating patients with iron deficiency with intravenous iron. Across the UK, heart failure services vary hugely with care being delivered within primary care, secondary care or a combination of both. Some services are based mainly in primary care while others are primarily provided in hospitals. There is a third group with a combination of care delivered by primary care and hospitals. Therefore, when developing an intravenous iron service, there is no one model that fits all. In this manuscript, we provide an overview of iron deficiency in heart failure patients along with describing the key considerations when setting up an intravenous iron therapy service for heart failure patients as well as our experience at the University Hospital of North Midlands....

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Intravenous iron therapies and their differences

February 2021 Br J Cardiol 2021;28(suppl 1):S10–S14

Intravenous iron therapies and their differences

Paul Foley

Abstract

Iron deficiency in heart failure patients with reduced ejection fraction is common. Iron replacement is being evaluated in clinical studies based on trials demonstrating a symptomatic improvement in patients treated with intravenous iron. Unfortunately, oral iron appears ineffective based on current evidence and due to physiological changes to iron uptake and distribution in heart failure patients. Iron preparations vary in the ability to provide a sufficient dose to correct iron deficiency, and some preparations are more prone to side effects, especially hypo-phosphataemia. Historical concerns about the risk of anaphylaxis largely relate to withdrawn older preparations, as modern irons have impressive safety profiles and efficacy. Meta-analysis of relatively small studies suggests intravenous iron can improve clinical outcomes and mortality, which will be examined in ongoing clinical trials....

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February 2021 Br J Cardiol 2021;28(suppl 1):S15–S18

Iron deficiency – the invisible comorbidity in HF: prioritising QoL as a target for treatment

Jacquelyn Hooper, Nick Hartshorne-Evans, Colin Cunnington, Fozia Zahir Ahmed

Abstract

This article explores the benefits of routine screening and treatment of iron deficiency in patients with heart failure, taking into account patient-centered outcome goals....

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February 2021 Br J Cardiol 2021;28(suppl 1):S19

Conclusions

Iain Squire

Abstract

In this collection of articles we have attempted to crystallise the issues surrounding what we now recognise as a highly prevalent, and clinically relevant issue, iron deficiency in heart failure. As Eltayeb and colleagues have described,1 iron deficiency is highly prevalent in patients with heart failure and is associated with adverse outcomes, in terms of both quality and quantity of life. We have also seen that the body of evidence to date supports intravenous (IV) supplementation of iron in heart failure, in iron-deficient patients, irrespective of the presence or absence of anaemia....

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