Management of Iron Deficiency in Heart Failure

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-12-01 DOI:10.1016/j.jchf.2024.05.014

Kazuhiko Kido PharmD , Craig J. Beavers PharmD , Kenneth Dulnuan MD , Nadia Fida MD , Maya Guglin MD, PhD , Onyedika J. Ilonze MD , Robert J. Mentz MD , Nikhil Narang MD , Navin Rajagopalan MD , Bhavadharini Ramu MD , Yasar Sattar MD , George Sokos DO , Ewa A. Jankowska MSc, MD, PhD

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Abstract

Iron deficiency (ID) is present in approximately 50% of patients with heart failure (HF) and even higher prevalence rate up to 80% in post-acute HF setting. The current guidelines for HF recommend intravenous (IV) iron replacement in HF with reduced or mildly reduced ejection fraction and ID based on clinical trials showing improvements in quality of life and exercise capacity, and an overall treatment benefit for recurrent HF hospitalization. However, several barriers cause challenges in implementing IV iron supplementation in practice due, in part, to clinician knowledge gaps and limited resource availability to protocolize routine utilization in appropriate patients. Thus, the current review will discuss practical considerations in ID treatment, implementation of evidence-based ID treatment to improve regional health disparities with toolkits, inclusion/exclusion criteria of IV iron supplementation, and clinical controversies in ID treatment, as well as gaps in evidence and questions to be answered.

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心力衰竭患者缺铁的管理：基于证据的铁质补充的实际考虑和实施。

大约 50%的心力衰竭（HF）患者存在铁缺乏症（ID），在急性心力衰竭后的患者中，铁缺乏症的发病率甚至高达 80%。现行的高血压指南建议，对于射血分数降低或轻度降低的高血压患者和缺铁性心力衰竭患者，应静脉注射铁剂，因为临床试验显示，铁剂可改善患者的生活质量和运动能力，并对高血压患者的复发性住院治疗有总体益处。然而，在实践中实施静脉注射铁剂补充治疗存在一些障碍，部分原因是临床医生的知识差距和资源有限，无法为合适的患者制定常规使用方案。因此，本综述将讨论ID治疗中的实际考虑因素、实施循证ID治疗以通过工具包改善地区健康差异、静脉补铁的纳入/排除标准、ID治疗中的临床争议以及证据差距和有待回答的问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.