IV Iron for Heart Failure: Benefits and Guidelines for Clinical Pharmacists
Overview
As a clinical pharmacist, you'll hear about using IV iron to improve heart failure symptoms. Up to 20% of heart failure patients are iron deficient, leading to fatigue and exercise intolerance.
Evidence shows treating iron deficiency helps patients with moderate symptomatic systolic heart failure. They feel better, walk further, and have a better quality of life. Benefits are seen in both anemic and non-anemic iron-deficient patients. Researchers target patients with serum ferritin < 100 ng/mL or 100 to 299 ng/mL with a transferrin saturation < 20%.
IV Iron Therapy: Dosing and Safety in Heart Failure Patients
Consider checking for iron deficiency or anemia in patients with symptomatic heart failure.
- For IV iron, use iron sucrose (Venofer, Ferosac, Sacrofer) 200 mg/week until iron stores are replete, then 200 mg/month for 4 to 6 months.
- IV iron replaces iron stores faster than oral iron, and the risk of anaphylaxis is very small with newer IV products (Venofer, Sacrofer, Feraheme).
- Monitor ferritin, transferrin saturation, and hemoglobin to ensure patients maintain sufficient iron stores.
Take-home pointsHeart failure patients benefit from IV iron therapy...
- Recognize iron deficiency affects up to 20% of heart failure patients, leading to fatigue and exercise intolerance.
- Treat iron deficiency in moderate symptomatic systolic heart failure to improve quality of life and increase walking distance.
- Check for iron deficiency or anemia in symptomatic heart failure patients, focusing on serum ferritin and transferrin saturation levels.
- Use iron sucrose (Venofer, Ferosac, Sacrofer) 200 mg/week until iron stores are replete, then 200 mg/month for 4 to 6 months.
- Monitor ferritin, transferrin saturation, and hemoglobin to maintain sufficient iron stores and ensure treatment effectiveness.
- Be aware of the low risk of anaphylaxis with newer IV iron products like Venofer, Sacrofer, and Feraheme.
References
- Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436-2448. doi:10.1056/NEJMoa0908355
- Okonko DO, Grzeslo A, Witkowski T, et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol. 2008;51(2):103-112. doi:10.1016/j.jacc.2007.09.036
Keywords: Heart failure management, HFrEF, Aldosterone antagonists, Spironolactone, Eplerenone, ACE inhibitors, ARB, Beta-blockers, Hyperkalemia, Clinical pharmacy
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