Fast Five Quiz: Management of Iron Deficiency in Heart Failure

Jeffrey J. Hsu, MD


March 03, 2021

Various intravenous iron formulations are available, including iron(III) gluconate, iron(III) hydroxide sucrose, iron(III) hydroxide polymaltose complex (ferric carboxymaltose), and ferumoxytol. Iron sucrose, ferric carboxymaltose, and ferumoxytol are newer formulations that enable the application of higher doses of iron in one sitting than their older counterparts. Most studies in patients with heart failure and iron deficiency have used either iron sucrose (maximum dose in one sitting: 200 mg) or ferric carboxymaltose (1000 mg). 

Intravenous iron can be administered either as a bolus using a simplified dosing regimen or as an infusion. In the positive CONFIRM-HF trial, a bolus was used, which enabled rapid intravenous iron administration, and there were no significant safety issues with this approach.

ACC/AHA guidelines recommend against using erythropoietin-stimulating agents in patients with heart failure and anemia to improve morbidity and mortality, owing to a lack of benefit.

Oral iron preparations should be taken 30-60 minutes before meals, as iron absorption is highest in the fasting state.

For additional information, refer to the heart failure treatment guidelines from the ESC and the ACC/AHA.

Learn more about managing iron deficiency in patients with heart failure.

Editor's Recommendations


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: