Fast Five Quiz: Iron Deficiency and Anemia in Heart Failure

Arnold S. Baas, MD; Jeff Hsu, MD


March 15, 2021

According to a report from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America, intravenous iron replacement has a class IIb recommendation for patients with NYHA class II or III heart failure and iron deficiency (ferritin level < 100 ng/mL or 100-300 ng/mL if transferrin saturation < 20%). Guidelines from the European Society of Cardiology note that intravenous ferric carboxymaltose may potentially lead to sustainable improvements in function, symptoms, and quality of life among patients with heart failure and anemia.

Although erythropoietin-stimulating agents have been shown to correct hemoglobin levels in patients with heart failure and anemia, there is inconclusive evidence to suggest that their use in treating anemia in patients with heart failure is beneficial. Data regarding clinical outcomes such as exercise parameters, quality of life, and hospitalizations are conflicting, and a mortality benefit has not been shown. In addition, increased rates of thromboembolic events and ischemic stroke have been noted with their use. As such, they are not recommended for patients with heart failure.

Learn more about recommendations for the treatment of heart failure.


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