Çavuşoğlu Yüksel, Altay Hakan, Çetiner Mustafa, Güvenç Tolga Sinan, Temizhan Ahmet, Ural Dilek, Yeşilbursa Dilek, Yıldırım Nesligül, Yılmaz Mehmet Birhan
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Turk Kardiyol Dern Ars. 2017 Mar;45(Suppl 2):1-38. doi: 10.5543/tkda.2017.79584.
Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.
心力衰竭是一个重要的社区健康问题。多年来，心力衰竭的患病率和发病率持续上升。尽管近年来心力衰竭治疗取得了进展，但预后仍然很差，再住院率非常高，生活质量也较差。心力衰竭的合并症对疾病的临床进程有负面影响，进一步损害预后，并给临床治疗带来困难。因此，除了心力衰竭的常规治疗外，强烈建议成功管理合并症。心力衰竭最常见的合并症之一是缺铁和贫血。目前的证据表明，缺铁和贫血在射血分数降低的心力衰竭患者以及射血分数保留的心力衰竭患者中更为普遍。此外，缺铁和贫血被认为是心力衰竭预后不良的独立预测因素。缺铁或贫血与心力衰竭临床状态的严重程度之间存在密切关系。在过去二十年中，已经对口服铁剂、静脉铁剂和促红细胞生成素治疗缺铁或贫血的临床效果进行了许多临床研究。口服铁剂和促红细胞生成素治疗的研究没有提供任何临床益处，事实上，这些治疗已被证明与不良临床结局的增加有关。然而，在有或没有贫血的缺铁患者中进行的临床试验表明静脉铁剂治疗有相当大的临床益处，基于这些积极结果，缺铁已成为心力衰竭管理中的治疗靶点。本报告根据最近的证据评估了目前心力衰竭中铁缺乏和贫血的治疗方法。
