Skill Checkup: A 71-Year-Old Man With History of Chronic Heart Failure Presents With Dyspnea, Rales, and Ankle Swelling

Marco Guazzi, MD, PhD


May 02, 2022

Iron deficiency with or without anaemia is seen in about 50% of patients with chronic HF and ≤ 80% of those with acute HF. Therefore, all patients with HF should be routinely screened for anaemia and iron deficiency with full blood count, serum ferritin concentration, and low transferrin saturation (TSAT).

The ESC guidelines recommend that intravenous iron supplementation with ferric carboxymaltose be considered in patients with symptomatic HF who were recently hospitalized for HF, LVEF ≤ 50%, and iron deficiency. The goal of this strategy is to reduce the risk for HF hospitalization. In this setting, iron deficiency is defined as serum ferritin < 100 ng/mL or serum ferritin 100-299 ng/mL with TSAT < 20%.

Erythropoietin-stimulating agents are not indicated for the treatment of anaemia in HF. This recommendation is based on the results from the only large-scale randomized trial in patients with HFrEF and mild to moderate anaemia, which concluded that darbepoetin-alpha did not reduce all-cause death or HF hospitalization, and in fact increased the risk for thromboembolic events.


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