Fast Five Quiz: Management of Iron Deficiency in Heart Failure

Jeffrey J. Hsu, MD


March 03, 2021

Intravenous iron replacement is recommended for patients with heart failure and ferritin levels < 100 ng/mL or 100-300 ng/mL if TSAT is < 20%, for improvement of functional status and quality of life.

Treatment of iron deficiency should be considered regardless of whether the patient has developed anemia. Iron deficiency can be particularly severe in patients with heart failure, even when anemia is not present, and can aggravate the underlying disease and have a negative impact on symptoms, quality of life, exercise capacity, and clinical outcomes. A study of patients with stable systolic heart failure found that iron deficiency with and without anemia was an independent predictor of death or heart transplant.

Oral iron therapy is often a first-line therapy for iron deficiency in patients with heart failure, although it tends to be poorly tolerated, with gastrointestinal side effects occurring in up to 60% of patients.

The efficacy and safety of iron replacement have not been evaluated in patients with hemoglobin levels > 15 g/dL; as such, it is not recommended in this patient population.

Learn more about treatment options for patients with heart failure and concomitant anemia.


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