Tag Archives: heart failure

There are many major challenges in managing cardiorenal syndrome, its prevalence is high (in 30% of hospitalised patients with heart failure),5 it is associated with a wide range of comorbidities, its diagnostic criteria remain arbitrary, the fine balance between potential damage and therapeutic effect with the current medical treatment is hard to strike, its prognosis remains poor and its prevention has been hardly explored by the medical profession. Prevention is better than cure Prevention of cardiorenal syndrome, as in other medical conditions, would be much more fruitful than any treatment once occurred. The current prevention of cardior

Introduction Heart failure (HF) is a clinical syndrome characterised by breathlessness, leg swelling and fatigue, which is caused by a primary cardiac abnormality. HF can be categorised into HF with a reduced ejection fraction (HFrEF; ejection fraction <50%) or HF with a preserved ejection fraction (HFpEF; ejection fraction >50%).1 It was estimated in 2012, in Ireland, that 90,000 people had HF, with another 160,000 people at risk of developing the disease.2 There are also an estimated 10,000 new cases of HF every year.2 Both prevalence and incidence have likely increased since 2012 due to the ageing population and increases in comorbid

Contents Prevalence, causes, diagnosis and guidelines for treatment Mohamed Eltayeb, Vishnu Ashok, Iain Squire United Kingdom treatment of iron deficiency in heart failure: are we missing opportunities? Chun Shing Kwok, Sarah McDermott, Sadie Bennett, Simon Duckett Intravenous iron therapies and their differences Paul Foley Iron deficiency – the invisible comorbidity in HF: prioritising QoL as a target for treatment Jacquelyn Hooper, Nick Hartshorne-Evans, Colin Cunnington, Fozia Zahir Ahmed Conclusions Iain Squire

Pathophysiology Anaemia is a common comorbidity in heart failure (HF) and is strongly associated with disease severity, prognosis and mortality.1 The pathophysiology behind the high prevalence of anaemia in HF, and its association with adverse outcomes, is complex and multi-factorial.2 Some of the key factors involved include renal impairment, chronic inflammation, medications and haematinic deficiency, in particular iron deficiency (ID).3 ID is typically defined as a serum ferritin level <30 µg/L and transferrin saturation <20%.4 ID has better predictive value in identifying risk of long-term unfavourable outcomes in patients with chr

Introduction Iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF) is common, affecting 60% of patients with hospitalisation for heart failure or worsening heart failure in the outpatient setting.1 Patients with heart failure are iron deficient for multiple reasons, including poor nutrition, malabsorption, reduced intracellular uptake of iron and blood loss.2 Two meta-analyses of randomised-controlled trials (RCTs) have shown the benefits of restoring iron levels in improving quality of life, exercise tolerance and reducing hospitalisation for heart failure, although, as of yet, no mortality benefit has been se

Introduction Iron deficiency has a major impact on cellular function, which is important in patients with heart failure with reduced ejection fraction because the prevalence is high. Interestingly, iron deficiency is not synonymous with anaemia – 50–73% of heart failure (HF) patients are iron deficient, yet 46% are not anaemic.1 The familiar response to treatment with iron, an increase in haemoglobin, does not always occur with iron treatment in patients with heart failure, yet replenishment does improve mitrochondrial function. It is notable that iron-containing proteins have a vital role in cellular energy metabolism. Remarkably, very

Introduction Despite significant advances in treatment, many patients with heart failure (HF) have poor outcomes, with one- and five-year mortality worse than most cancers.1 In view of this, improving quality of life (QoL) for patients with HF is considered a key target for treatment.2-4 Among patients with HF, iron deficiency (ID) is prevalent and affects up to 50% of patients.5 Like HF, ID is not only associated with increased morbidity and mortality, but it is also associated with reduced QoL.6,7 As the predominant symptoms of ID (fatigue, breathlessness and lethargy) particularly with anaemia, are often indistinguishable from those of HF,

Professor Iain Squire However, identification of patients with iron deficiency is challenging and awareness of the importance of iron deficiency varies widely among clinicians caring for patients with heart failure; consequently, implementation of guideline-recommended IV iron supplementation is inconsistent, resulting in a large proportion of potentially eligible patients missing out on this therapy. Kwok and colleagues2 have described their early experience in integrating IV iron supplementation into their heart failure service, a model for others looking to follow-suit. As described in each of the articles, the data supporting IV iron supp

Case An 81-year-old woman presented to our cardiac centre with acute onset ischaemic sounding chest pain during week 4 of the first COVID-19 lockdown in the UK. She reported increasing anxiety since the start of isolation. The onset of chest pain was related to a package dropped off by her family and occurred within an hour of receiving it. Although welcome, this caused her a mixed extreme of emotions as it both heightened her sense of loneliness and anxiety, while at the same time caused her pleasure from family contact. Her past medical history included permanent atrial fibrillation (AF), hypertension, hypercholesterolaemia and iron deficie

Introduction Cardiorenal syndromes (CRS) are defined as a spectrum of disorders affecting the heart and kidney, in which acute or chronic dysfunction of one organ leads to acute or chronic dysfunction of the other.1,2 Management of this condition can be challenging as it portends significant morbidity due to symptom burden, as well as recurrent hospitalisations and increased mortality.1-3 In addition, as there is a relative paucity of evidence-based therapy, management strategies for CRS have been largely empirical and goal-directed towards improvement of function of one organ, frequently at the cost of the other. For instance, acute kidney i