Anemia?Iron Deficiency In Heart Failure

Heart failure is the final and severe stage of all cardiac disease,with severe morbidity and mortality.Heart failure is associated with a variety of comorbidities,such as anemia,iron deficiency,renal dysfunction,chronic lung disease,sleep,respiratory diseases,etc.,which affect the quality of life and prognosis of patients.Anemia is common in heart failure.The incidence of anemia in different studies varies between 4%-70%.The causes of anemia are complex and multiple,including iron deficiency,hemodilution,erythropoietin production and activity.Furthermore other concomitant causes of anemia,such as myelodysplastic syndrome and chemotherapy,may worsen the outcome.Anemia results in lower cardiac function,longer hospital stay,increased rehospitalization rate,and increased mortality.A retrospective study from Fu Wai Hospital enrolled a large cohort of hospitalized patients with HF according to current Chinese guidelines,all patients were divided into 2 groups:anemia and non-anemia.The endpoint was all-cause death of admission.Kaplan-Meier survival analysis showed patients with anemia a higher risk than those with non-anemia.Based on the pathophysiology of cardiac anemia,there are several therapeutic options that may improve hemoglobin levels,tissues' oxygenation,and probably the outcome.These include administration of iron,erythropoiesis-stimulating agents,and blood transfusions..Iron deficiency is common comorbidity in HF,and it can lead to anemia and/or skeletal muscle dysfunction.ID is associated with a worse prognosis.ID is devided into absolute or functional iron deficiency.A number of studies have shown that iron supplementation can correct anemia in patients with heart failure and can increase the 6 minute walking distance and peak oxygen consumption in patients with heart failure,thereby reducing mortality and improving prognosis.The choice of iron supplements is intravenous iron supplementation and oral iron supplementation.A number of clinical studies showed that intravenous iron supplementation is safe and effective,can quickly improve the iron storage.Recommended in the 2016 European Society of Cardiology heart failure guidelines,intravenous FCM should be considered in symptomatic patients with iron deficiency.The effectiveness of oral iron supplementation remains controversial.