Iron deficiency and heart failure

Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency (ID) is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinic...

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Autores principales: Perel, C., Bevacqua, R.J.
Formato: JOUR
Materias:
Anemia
Heart failure
Hepcidin
Intravenous
Iron
Iron deficiency
Iron therapy
Oral
Quality of life
Acceso en línea:http://hdl.handle.net/20.500.12110/paper_18501044_v11_n2_p78_Perel
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Biblioteca Digital - Facultad de Ciencias Exactas y Naturales (UBA) de Universidad de Buenos Aires
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spelling todo:paper_18501044_v11_n2_p78_Perel2023-10-03T16:33:12Z Iron deficiency and heart failure Perel, C. Bevacqua, R.J. Anemia Heart failure Hepcidin Intravenous Iron Iron deficiency Iron therapy Oral Quality of life Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency (ID) is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. ID affects up to 50% of HF patients, being particularly common in the elderly and patients with certain chronic diseases. The prevalence of iron deficiency is higher in the more advanced stages of HF, in women, in patients with elevated levels of inflammatory markers (e.g. C-reactive protein) as well as increased NT-proBNP. But even in low-risk patients such as NYHA I-II the prevalence remains at over 30%. ID is associated with a poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. International Guidelines recommend a diagnostic work-up for iron deficiency in patients with suspected HF. Data indicate that ID has detrimental effects in patients with coronary artery disease, HF, and pulmonary hypertension, and possibly in patients undergoing cardiac surgery. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in HF due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. Intravenous (IV) iron administration has been shown to improve exercise capacity, symptom severity, and quality of life. Evidence suggests that these improvements occur independently of the presence of anemia. Similar findings were observed in patients with systolic HF and impaired ejection fraction in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. IV iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of ID in patients with symptomatic HF regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using IV iron therapy should now be considered, while still having into account that excess iron can be detrimental in cardiovascular disease. This update will review the iron metabolism in the context of anemia and HF; as well as the importance of early diagnosis and treatment of ID with IV iron in patients with HF. © 2016 Silver House. JOUR info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by/2.5/ar http://hdl.handle.net/20.500.12110/paper_18501044_v11_n2_p78_Perel
institution Universidad de Buenos Aires
institution_str I-28
repository_str R-134
collection Biblioteca Digital - Facultad de Ciencias Exactas y Naturales (UBA)
topic Anemia
Heart failure
Hepcidin
Intravenous
Iron
Iron deficiency
Iron therapy
Oral
Quality of life
spellingShingle Anemia
Heart failure
Hepcidin
Intravenous
Iron
Iron deficiency
Iron therapy
Oral
Quality of life
Perel, C.
Bevacqua, R.J.
Iron deficiency and heart failure
topic_facet Anemia
Heart failure
Hepcidin
Intravenous
Iron
Iron deficiency
Iron therapy
Oral
Quality of life
description Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency (ID) is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. ID affects up to 50% of HF patients, being particularly common in the elderly and patients with certain chronic diseases. The prevalence of iron deficiency is higher in the more advanced stages of HF, in women, in patients with elevated levels of inflammatory markers (e.g. C-reactive protein) as well as increased NT-proBNP. But even in low-risk patients such as NYHA I-II the prevalence remains at over 30%. ID is associated with a poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. International Guidelines recommend a diagnostic work-up for iron deficiency in patients with suspected HF. Data indicate that ID has detrimental effects in patients with coronary artery disease, HF, and pulmonary hypertension, and possibly in patients undergoing cardiac surgery. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in HF due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. Intravenous (IV) iron administration has been shown to improve exercise capacity, symptom severity, and quality of life. Evidence suggests that these improvements occur independently of the presence of anemia. Similar findings were observed in patients with systolic HF and impaired ejection fraction in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. IV iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of ID in patients with symptomatic HF regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using IV iron therapy should now be considered, while still having into account that excess iron can be detrimental in cardiovascular disease. This update will review the iron metabolism in the context of anemia and HF; as well as the importance of early diagnosis and treatment of ID with IV iron in patients with HF. © 2016 Silver House.
format JOUR
author Perel, C.
Bevacqua, R.J.
author_facet Perel, C.
Bevacqua, R.J.
author_sort Perel, C.
title Iron deficiency and heart failure
title_short Iron deficiency and heart failure
title_full Iron deficiency and heart failure
title_fullStr Iron deficiency and heart failure
title_full_unstemmed Iron deficiency and heart failure
title_sort iron deficiency and heart failure
url http://hdl.handle.net/20.500.12110/paper_18501044_v11_n2_p78_Perel
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