Sirbu Oana, Tirnoveanu Andreea, Haliga Raluca Ecaterina, Sorodoc Victorita, Sava Miruna, Bologa Cristina, Petris Ovidiu Rusalim, Morarasu Bianca Codrina, Diaconu Alexandra Diana, Ceasovschih Alexandr, Lionte Catalina, Morariu Paula Cristina, Morariu Branco Adrian, Statescu Cristian, Sascau Radu Andy, Floria Mariana, Sorodoc Laurentiu
Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania.
Department of Internal Medicine, St. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania.
Biomedicines. 2025 Sep 19;13(9):2296. doi: 10.3390/biomedicines13092296.
Iron deficiency (ID) is a frequent comorbidity in heart failure (HF), associated with reduced functional capacity and poor prognosis. Although the European Society of Cardiology (ESC) guidelines recommend systematic screening and intravenous iron supplementation (IS), adherence in clinical practice remains limited. This observational study aimed to evaluate how these recommendations are implemented into practice. We performed a retrospective study including 4348 patients hospitalized with HF (NYHA II-IV) in a tertiary internal medicine clinic in Eastern Europe between January 2018 and September 2022. Demographic data, comorbidities, laboratory parameters, echocardiographic findings were collected from electronic medical records. IS was defined as serum ferritin < 100 ng/mL. Among HF patients, 2547 (58.7%) were screened for ID, and 1091 (42.8%) had absolute deficiency. Only 278 patients (25.5%) received intravenous ferric carbodymaltose. Treated patients were predominantly elderly (70.1% ≥ 70 years), female (60.4%), and often had ischemic or valvular disease. Patients receiving intravenous IS showed higher NT-proBNP and troponin levels. A progressive increase in IS use was observed during the study period, with a temporary decline during the COVID-19 pandemic. Despite relatively high screening rates, only one-quarter of HF patients with confirmed ID received intravenous IS. These findings highlight persistent gaps between guidelines and clinical practice, emphasizing the need for improved awareness and implementation of ESC recommendations to optimize outcomes in HF patients with ID.
缺铁（ID）是心力衰竭（HF）中常见的合并症，与功能能力下降和预后不良相关。尽管欧洲心脏病学会（ESC）指南建议进行系统筛查和静脉补铁（IS），但临床实践中的依从性仍然有限。这项观察性研究旨在评估这些建议在实际中的实施情况。我们进行了一项回顾性研究，纳入了2018年1月至2022年9月期间在东欧一家三级内科诊所住院的4348例HF患者（纽约心脏协会II-IV级）。从电子病历中收集人口统计学数据、合并症、实验室参数、超声心动图检查结果。IS定义为血清铁蛋白<100 ng/mL。在HF患者中，2547例（58.7%）接受了ID筛查，1091例（42.8%）存在绝对缺铁。只有278例患者（25.5%）接受了静脉注射羧麦芽糖铁。接受治疗的患者主要为老年人（70.1%≥70岁）、女性（60.4%），且常患有缺血性或瓣膜性疾病。接受静脉IS治疗的患者NT-proBNP和肌钙蛋白水平较高。在研究期间观察到IS使用呈逐步增加趋势，在新冠疫情期间有短暂下降。尽管筛查率相对较高，但确诊ID的HF患者中只有四分之一接受了静脉IS治疗。这些发现凸显了指南与临床实践之间持续存在的差距，强调需要提高对ESC建议的认识并加以实施，以优化ID HF患者的治疗效果。
