Co-morbidity (HFrEF and HFpEF): anaemia/iron deficiency

Abstract

Anaemia is a frequent co-morbidity in patients with heart failure (HF), its prevalence increases with disease severity, and it is associated with poor outcomes. The aetiology of anaemia in HF is multifactorial, with the following common underlying causes: gastrointestinal bleeding, renal dysfunction, haemodilution, haematinic deficiencies, deranged steroid metabolism, bone marrow dysfunction and iron deficiency (ID). Erythropoiesis-stimulating agents to correct anaemia in HF did not improve mortality and raised safety concerns, thus are not recommended in these patients. ID in HF has been traditionally linked with anaemia; however, recent studies report a high prevalence also in non-anaemic patients and independent adverse clinical and prognostic consequences (decreased exercise capacity, poor quality of life, and higher mortality) of this co-morbidity. A number of studies have demonstrated that ID can be safely corrected with intravenous iron (ferric carboxymaltose) with symptomatic improvement. According to the 2016 recent European Society of Cardiology Guidelines, an active screening for the presence of ID is recommended in all HF patients, and in symptomatic HF patients with reduced ejection fraction and with ID, intravenous ferric carboxymaltose should be considered to alleviate symptoms, and improve exercise capacity and quality of life. Ongoing trials are investigating the effects of ID correction in HF on mortality and morbidity.