Iron Deficiency in Elderly Patients with Heart Failure
Iron is not only fundamental for hemoglobin synthesis, but also for the production of other very important proteins. Its role is therefore not limited to hematopoiesis, as it has a broader function in human physiology. Consequently, iron deficiency may have detrimental effects beyond just the development of sideropenic anemia.
In recent years, for instance, different studies have demonstrated that iron deficiency has a negative effect on patients with heart failure, even in those with normal hemoglobin levels. A recent double-blind placebo-controlled randomized clinical trial (AFFIRM-AHF), published in The Lancet in 2020, evaluated the effect of intravenous iron supplementation in sideropenic subjects admitted to hospital due to heart failure.
1110 patients were randomly selected for either a placebo or treatment of intravenous ferric carboxymaltose. Only around half of them had a clinically overt iron deficiency. Iron supplementation was effective in lowering the risk of hospital re-admission due to heart failure; conversely, no effect was demonstrated with respect to cardiovascular mortality. The safety profile was comparable between the two groups.
On the basis of this study, sideropenic patients with heart failure should be considered for iron supplementation. Though ineffective in reducing the risk of cardiovascular mortality, iron supplementation can reduce the number of hospitalizations due to heart failure.
