Iron deficiency is common in CHF and is associated with reduced functional capacity, impaired quality of life and a worse prognosis, irrespective of anaemia status Clinical trials of IV iron therapy conducted in patients with symptomatic HFrEF demonstrate that correction of iron deficiency is associated with significant improvements in exercise capacity, symptoms, health‐related quality of life, and possible reductions in recurrent hospitalizations
|
|
In whom and when to give IV iron therapy?
|
IV FCM should be considered in symptomatic patients with chronic systolic HFrEF (LVEF <40%) and iron deficiency (class of recommendation IIa, level of evidence A) Iron deficiency can be diagnosed based on the following cut‐offs: serum ferritin <100 µg/L, or serum ferritin 100–299 µg/L when TSAT† <20%
Hypersensitivity to the active substance, to FCM, or any of its excipients Known serious hypersensitivity to other parenteral iron products Anaemia not attributed to iron deficiency, e.g. other microcytic anaemia Evidence of iron overload or disturbances in the utilization of iron
Use with caution in patients with acute or chronic infection; treatment with FCM should be stopped in patients with ongoing bacteraemia Patients with known drug allergies, including those with a history of severe asthma, eczema or other atopic allergies, may be at an increased risk of hypersensitivity reaction Increased risk of hypersensitivity reactions to parenteral iron complexes in patients with immune or inflammatory conditions (e.g. systemic lupus erythematosus and rheumatoid arthritis) No clinical evidence for IV FCM in patients with HFpEF (LVEF ≥ 50%) and limited clinical evidence in HFmrEF (LVEF 40–49%) The efficacy and safety of IV FCM has not been evaluated in patients with Hb level > 15 g/dL
|
|
Which iron preparation/route?
|
IV iron therapy with FCM is recommended by the current 2016 ESC HF guidelines (class of recommendation IIa, level of evidence A) Oral iron therapy has not been shown to be an effective treatment option for iron deficiency in patients with CHF
|
|
How should IV iron be administered?
|
Determination of the initial iron need is calculated based on body weight and Hb levels (see dosing table in Figure
1) FCM may be given intravenously as an undiluted slow bolus injection, or an infusion that requires dilution. If given as infusion, it should not be over‐diluted (see dilution plan in Table
3) The maximum recommended cumulative dose of FCM is 1000 mg of iron (20 mL FCM)/week Patients should be observed for adverse effects for at least 30 min following each IV injection
|
|
Where to perform the treatment?
|
IV FCM can be administered in the hospital or community setting, where staff are trained and equipped to monitor for and manage hypersensitivity reactions
|
|
Monitoring of iron status
|
Following replacement, iron status should be re‐evaluated in 3 months and further iron repletion provided as needed, as well as evaluation for blood loss as indicated Early re‐evaluation of iron status (i.e. within 4 weeks of IV iron administration) should be avoided as ferritin levels increase markedly following IV iron administration, and cannot be used as an indicator of iron status during this time Consider evaluating iron status as part of routine practice in patients with known CHF (1–2 times per year) or when symptoms remain despite receiving optimal background HF medications
|
