Thammitage Maleesha Bw, Moussa Naji, Rezvani Ali, Dhillon Damandeep Kaur, Gamarra Miryam Lisseth Obando, Singh Kanwaraj, Hawwa Abdul, Vincente Alejandra Felix, Kaur Sehajpreet, Nemalapuri Kiranmayee Seshasai, Poonwassie Devika, Rai Manju
Aloka Medical Center, Horona, Ratnapura, Sri Lanka.
Department of Cardiology, Richmond Gabriel University, Kingstown, St. Vincent, Caribbean.
Curr Cardiol Rev. 2025;21(3):30-43. doi: 10.2174/011573403X331380241111091452.
Iron deficiency anemia (IDA) is highly prevalent among individuals with heart failure (HF), impacting 40-70% of patients and serving as a significant prognostic indicator. Linked with oxidative metabolism and myocardial cell damage, IDA exacerbates HF symptoms, including reduced exercise capacity, diminished quality of life, and heightened cardiovascular morbidity. This review explores the diagnosis, treatment, clinical outcomes, prognostic indicators, and forthcoming challenges associated with IDA in HF patients. Crucially, addressing IDA in HF is critical for enhancing prognosis, including clinical outcomes, quality of life, hospitalizations, and survival rates. While oral iron therapy shows efficacy in reducing mortality and hospitalizations, it falls short in improving exercise capacity and quality of life, often deterring patients due to side effects. In contrast, intravenous (IV) iron therapy is highly effective in enhancing hematological parameters, functional capacity, and reducing HF hospitalizations. Optimizing IV iron dosing based on individual patient characteristics is essential for balancing treatment efficacy and adverse effects. Emphasizing individualized approaches, with IV iron emerging as a superior option, underscores the necessity for ongoing research to refine dosing strategies and explore novel therapies. Compliance remains paramount for positive outcomes with IDA treatment, with oral supplementation being cost-effective and easily accessible. However, parenteral supplementation proves beneficial for patients intolerant to oral therapy. Addressing IDA through tailored interventions, including oral or parenteral supplementation, is pivotal in averting complications and improving outcomes in HF patients. This paper consolidates insights into the diagnosis, treatment, impact, pathophysiology, clinical outcomes, research gaps, and future directions concerning IDA in HF patients, drawing on extensive literature to offer a comprehensive understanding of this critical issue.
缺铁性贫血（IDA）在心力衰竭（HF）患者中极为普遍，影响40%-70%的患者，并作为一个重要的预后指标。IDA与氧化代谢和心肌细胞损伤相关，会加重HF症状，包括运动能力下降、生活质量降低以及心血管发病率升高。本综述探讨了与HF患者IDA相关的诊断、治疗、临床结局、预后指标及未来挑战。至关重要的是，解决HF患者的IDA问题对于改善预后至关重要，包括临床结局、生活质量、住院率和生存率。虽然口服铁剂治疗在降低死亡率和住院率方面显示出疗效，但在改善运动能力和生活质量方面效果不佳，且常常因副作用使患者望而却步。相比之下，静脉注射（IV）铁剂治疗在提高血液学参数、功能能力以及减少HF住院方面非常有效。根据个体患者特征优化IV铁剂剂量对于平衡治疗效果和不良反应至关重要。强调个体化方法，IV铁剂成为更优选择，这凸显了持续研究以完善给药策略和探索新疗法的必要性。对于IDA治疗取得积极结果而言，依从性仍然至关重要，口服补充剂具有成本效益且易于获取。然而，肠外补充剂对不耐受口服治疗的患者有益。通过量身定制的干预措施（包括口服或肠外补充）解决IDA问题，对于避免并发症和改善HF患者的结局至关重要。本文综合了有关HF患者IDA诊断、治疗、影响、病理生理学、临床结局、研究差距及未来方向的见解，借鉴大量文献以全面理解这一关键问题。
