Skill Checkup: A 69‐Year‐Old Woman With Acutely Worsening Heart Failure

Marco Guazzi, MD, PhD

Disclosures

March 21, 2022

The ESC guidelines recommend treatment with IV ferric carboxymaltose in symptomatic HF patients with iron deficiency. The US guidelines do not recommend a specific formulation.

Risk factors for iron deficiency in HF include female sex, advanced HF, and higher levels of N-terminal pro–B-type natriuretic peptide and C-reactive protein. Three main mechanisms underlie the deficiency: low iron intake, which depends on diet; decreased iron absorption, which is associated with gastrointestinal abnormalities; and increased iron loss, owing to hemorrhages or proteinuria.

Finally, the AFFIRM-AHF trial showed that IV ferric carboxymaltose treatment in patients with iron deficiency who have stabilized after an acute HF episode reduced the risk of future HF hospitalizations.

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