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Anemia and iron deficiency in heart failure: mechanisms and therapeutic approaches

Nature Reviews Cardiology volume 8, pages 485493 (2011) | Download Citation

Abstract

Anemia and iron deficiency are common in patients with heart failure (HF), and are associated with worse symptoms and adverse outcomes in this population. Although the two can occur together, anemia in HF is often not caused by iron deficiency, and iron deficiency can be present without causing anemia. Erythropoiesis-stimulating agents have been investigated extensively in the past few years and might be of benefit in patients with HF and anemia. However, concerns have arisen regarding the safety of erythropoiesis-stimulating agents in patients with chronic kidney disease and so the results of a large mortality trial are eagerly awaited to provide information on safety in patients with HF. Iron supplementation or replacement is a much older treatment option for patients with HF and anemia, but questions about the safety of intravenous iron, and absorption problems with oral formulations have prevented its widespread use to date. In the past few years, however, new data on the importance of iron deficiency in HF have become available, and a number of studies with intravenous iron have shown promising results. Therefore, this treatment approach is likely to become an attractive option for patients with HF and iron deficiency, both with and without anemia.

Key points

  • Anemia and iron deficiency are both common and important in the setting of heart failure

  • Anemia is associated with increased morbidity and mortality among patients with heart failure

  • Iron deficiency, both with and without anemia, is also associated with adverse clinical outcomes

  • Treatment of patients with heart failure and anemia with erythropoiesis-stimulating agents could have beneficial clinical effects, but the results of a large-scale ongoing trial (RED-HF) must be awaited

  • Intravenous, but not oral, iron supplementation might be beneficial in the treatment of patients with heart failure and iron deficiency

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Affiliations

  1. Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands

    • Dirk J. van Veldhuisen
  2. Applied Cachexia Research, Department of Cardiology, Campus Virchow-Klinikum, Charité Universitätsmedizin, Augustenburger Platz 1, D-13353 Berlin, Germany

    • Stefan D. Anker
  3. Department of Heart Diseases, Medical University, Military Hospital, Weigla 5, 50-891 Wroclaw, Poland

    • Piotr Ponikowski
  4. Department of Renal Medicine, King's College Hospital, London SE5 9RS, UK

    • Iain C. Macdougall

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Contributions

All authors contributed to discussion of content for the article. After the first version, which was written by D. J. van Veldhuisen, all authors researched data to include in the manuscript, and all wrote parts of the manuscript. All authors reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

Competing interests

D. J. van Veldhuisen, S. D. Anker and P. Ponikowski have been consultants for and received grant/research support from Amgen (manufacturer of darbepoetin alfa) and Vifor (manufacturer of ferric carboxymaltose [intravenous iron]). In addition, S. D. Anker and P. Ponikowski have received speakers bureau (honoraria) from Vifor, and P. Ponikowski has also received speakers bureau from Amgen. I. C. Macdougall has been a consultant for and received speakers bureau and grant/research support from Amgen, Ortho Biotech, Roche and Vifor. In addition, I. C. Macdougall has been a consultant for and received grant/research support from Affymax.

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Correspondence to Dirk J. van Veldhuisen.

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https://doi.org/10.1038/nrcardio.2011.77

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