From the Guidelines
Low iron saturation should be treated with intravenous iron replacement, as it has been shown to improve functional status and quality of life in patients with heart failure and iron deficiency, as demonstrated in the FAIR-HF and CONFIRM-HF trials 1. To address low iron saturation, it is essential to understand that it indicates a lack of sufficient iron bound to transferrin, the protein responsible for transporting iron in the bloodstream. The most effective treatment approach is to replenish iron stores, and intravenous iron replacement is recommended for patients with heart failure and iron deficiency, as evidenced by the 2017 ACC/AHA/HFSA focused update on the management of heart failure 1. In addition to intravenous iron, dietary changes can help increase iron intake, such as consuming more red meat, spinach, beans, and fortified cereals. However, the use of intravenous iron has been shown to be more effective than oral iron supplements in improving functional capacity and quality of life in patients with heart failure and iron deficiency, as demonstrated in the FAIR-HF and CONFIRM-HF trials 1. It is crucial to note that low iron saturation can progress to iron deficiency anemia if left untreated, leading to fatigue, weakness, and reduced exercise capacity due to the body's inability to produce enough hemoglobin for oxygen transport. Therefore, prompt treatment with intravenous iron replacement is necessary to improve outcomes and quality of life in patients with low iron saturation and heart failure, as recommended by the 2017 ACC/AHA/HFSA guidelines 1. Key points to consider when treating low iron saturation include:
- Intravenous iron replacement is the recommended treatment approach for patients with heart failure and iron deficiency
- Dietary changes can help increase iron intake, but are not a replacement for intravenous iron therapy
- Prompt treatment is necessary to improve outcomes and quality of life in patients with low iron saturation and heart failure
- The FAIR-HF and CONFIRM-HF trials provide evidence for the effectiveness of intravenous iron replacement in improving functional capacity and quality of life in patients with heart failure and iron deficiency 1.
From the Research
Low Iron Saturation Treatment
- Oral iron supplementation is the first line of treatment for iron-deficiency anemia and pre-anemic iron deficiency, with ferrous sulfate being the simplest and most commonly prescribed drug 2.
- Novel iron formulations, such as ferric maltol and nanoparticle encapsulated sucrosomial iron, have been developed to improve efficacy and tolerability 2.
- Intravenous iron therapy can be used when oral iron supplementation is contraindicated, and can rapidly achieve therapeutic targets without gastrointestinal complications 2, 3.
Oral Iron Supplementation Dosage and Frequency
- Recent studies suggest that oral iron doses of 60-120 mg given on alternate days may be an optimal regimen for women with iron-deficiency and mild IDA, as it can maximize fractional iron absorption and reduce side effects 4.
- Daily low-dose and every-other-day dosing protocols have been attempted to bypass the physiologic bottleneck of iron absorption, but have resulted in low fractional iron absorption 5.
- A prolonged release ferrous sulphate formulation has been shown to be non-inferior to a standard ferrous sulphate formulation in treating iron deficiency anaemia, with a better gastrointestinal tolerance profile 6.
Factors Affecting Iron Deficiency Treatment
- The presence of inflammation, time available for iron replenishment, and anticipated risk of side-effects or intolerance are factors that drive iron deficiency treatment selection 3.
- Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, and have applicability in a wide range of clinical contexts 3.