Treatment of anaemia and iron deficiency in chronic heart failure

Czech version

Authors: J. Vítovec ¹; J. Špinar ^2,3; L. Špinarová ¹
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ¹; Interní kardiologická klinika LF MU Brno ²; Mezinárodní centrum klinického výzkumu, Brno ³
Published in: Kardiol Rev Int Med 2014, 16(5): 364-369
Category: Cardiology Review

Overview

Iron deficiency is an important co‑ morbidity in patients with heart failure. 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 heart failure patients. Experimental evidence suggests that iron therapy in iron‑ deficient patients may activate molecular pathways that can be cardio‑ protective. Clinical studies have demonstrated favourable effects of IV iron on the functional status, quality of life, and exercise capacity in HF patients. IV iron supplementation has become a novel therapy in HF patients with iron deficiency.

Keywords:
anaemia – iron deficiency – heart failure – therapy of anaemia

Sources

1. Krč I. Diagnostika nejběžnějších typů anémie. Interní medicína pro praxi 2001; 2: 84– 88.

2. Tang YD, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation 2006; 113: 2454– 2461.

3. Hradec J. Anémie při chronickém srdečním selhání. Vnitř Lék 2010; 56: 854– 859.

4. Kosiborod M, Curtis JP, Wang Y et al. Anemia and Outcomes in Patients With Heart Failure. Arch Intern Med 2005; 165: 2237– 2244.

5. Komajda M, Anker SD, Charlesworth A et al. The impact of new onset anemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006; 27: 1440– 1446.

6. Jankowska EA, von Haehling S, Anker SD et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013; 34: 816– 829. doi: 10.1093/ eurheartj/ ehs224.

7. Nanas JN, Matsouka C, Karageorgopoulos D et al.Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006; 48: 2485– 2489.

8. Westenbrink BD, de Boer RA, Voors AA et al. Anemia in chronic heart failure: etiology and treatment options. Curr Opin Cardiol 2008; 23: 141– 147. doi: 10.1097/ HCO.0b013e3282f43025.

9. Andrews NC. Disorders of iron metabolism. N Engl J Med 1999; 341: 1986– 1995.

10. Wang J, Pantopoulos K. Regulation of cellular iron metabolism. Biochem J 2011; 434: 365– 381. doi: 10.1042/ BJ20101825.

11. Nemeth E, Ganz T. The role of hepcidin in iron metabolism. Acta Haematol 2009; 122: 78– 86. doi: 10.1159/ 000243791.

12. Pasricha SR, Flecknoe‑ Brown SC, Allen KJ et al.Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust 2010; 193: 525– 532.

13. Goddard AF, James MW, McIntyre AS et al. British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut 2011; 60: 1309– 1316. doi: 10.1136/ gut.2010.228874.

14. Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12,065 patients with new‑onset heart failure. Circulation 2003; 107: 223– 225.

15. Witte KK, Desilva R, Chattopadhyay S et al. Are hematinic deficiencies the cause of anemia in chronic heart failure? Am Heart J 2004; 147: 924– 930.

16. Nanas JN, Matsouka C, Karageorgopoulos D et al.Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006; 48: 2485– 2489.

17. Varma A, Appleton DL, Nusca A et al. Iron deficiency anemia and cardiac mortality in patients with left ventricular systolic dysfunction undergoing coronary stenting. Minerva Cardioangiol 2010; 58: 1– 10.

18. Jankowska EA, Rozentryt P, Witkowska A et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010; 31: 1872– 1880. doi: 10.1093/ eurheartj/ ehq158.

19. Bolger AP, Bartlett FR, Penston HS et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol 2006; 48: 1225– 1227.

20. Toblli JE, Lombrana A, Duarte P et al. Intravenous iron reduces NT‑ pro‑brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol 2007; 50: 1657– 1665.

21. Okonko DO, Grzeslo A, Witkowski T et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heartfailure and iron deficiency FERRIC‑ HF: a randomized, controlled, observerblinded trial. J Am Coll Cardiol 2008; 51: 103– 112.

22. Usmanov RI, Zueva EB, Silverberg DS et al. Intravenous iron without erythropoietin for the treatment of iron deficiency anemia in patients with moderate to severe congestive heart failure and chronic kidney insufficiency. J Nephrol 2008; 21: 236– 242.

23. Anker SD Comin‑Colet J, Filippatos G et al. FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436– 2448. doi: 10.1056/ NEJMoa0908355.

24. Jankowska EA, von Haehling S, Anker SD et al.Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013; 34: 816– 826. doi: 10.1093/ eurheartj/ ehs224.

25. Ponikovski P, van Veldhuisen DJ, Comin‑Colet J et al. CONFIRM‑ HF Investigators. Beneficial effects of long‑term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 2014; 31. doi:10.1093/ eurheartj/ ehu385.