Iron therapy in chronic heart disease what you need to know

Heart failure is a common disease, with severe morbidity and mortality, and is a frequent reason of hospitalization. Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome and consist of the cardio-renal anemia syndrome.

Anemia in heart failure is complex and multifactorial. Hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, and impaired erythropoietin production and activity are some pathophysiological mechanisms involved in anemia of the heart failure.

Cardiovascular diseases are among the most frequent causes of death worldwide. Heart failure is an enormous medical and societal burden and a leading cause of hospitalization. It is estimated that 2.6 millions hospitalizations annually in the USA are due to heart failure as a primary or secondary diagnosis.

Anemia is common in patients with heart disease. It is present in approximately one third of patients with congestive heart failure (CHF) and 10% to 20% of patients with coronary heart disease (CHD)

Anemia in heart failure patients. Alexandrakis MG, Tsirakis G. ISRN Hematol. 2012;2012:246915. doi: 10.5402/2012/246915.

Anemia is very common

More than one-quarter of the world's population is anemic. Approximately one-half of this burden is a result of iron deficiency anemia, being most prevalent among preschool children and women. The diagnosis, prevention, and treatment of iron deficiency is obviously a major public health goal, especially in low- and middle-income countries.

Chronic inflammation

Anemia of chronic inflammation is the most common cause of anemia and occurs in 58% of heart failure patients with anemia. Anemia of inflammation and chronic disease is a type of anemia that commonly occurs with chronic, or long term, illnesses or infections.

Inflammatory diseases that can lead to AI/ACD (Anemia of inflammation and chronic disease) include rheumatoid arthritis, which causes pain, swelling, stiffness, and loss of function in the joints, lupus, which causes damage to various body tissues and diabetes.


Therapy used today for anemia in congestive heart failure (CHF) and coronary heart disease (CHD)

Intravenous, IV iron therapy
Red Blood Cell, RBC transfusion
Erythropoiesis-stimulating agents (ESAs)

All three types of treatment have different health benefits and harms.

“The American College of Physicians, ACP recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease.”

“ACP recommends using a restrictive red blood cell transfusion strategy in hospitalized patients with coronary heart disease.”

“The effect of oral administration of iron and how it compares with IV (intravenously given) iron for treating anemic patients with heart disease is unknown.”

American College of Physicians (ACP) guideline

For oral administration efficacy and tolerance are central as well as easy administration.

The original OptiFer® heme iron supplements are considerably better taken up than oral non-heme iron and produce side-effects in the placebo range, as non-heme oral gives potentially therapy-destroying side-effects sooner or later.

Heme iron therapy is reasonably priced and much lower than for instance intravenous therapy in chronic cases. Side-effects will not ruin the therapy. Heme iron therapy has a much higher success rate due to tolerance than non-heme iron therapy.

Find out more at: www.optifer.international and www.hemeiron.com

Some more studies:

Anemia as a risk factor and therapeutic target in heart failure.

Felker et al. J Am Coll Cardiol. 2004 Sep 1;44(5):959-66. (https://www.ncbi.nlm.nih.gov/pubmed/15337204)

“Anemia has recently been recognized as an important comorbid condition and potentially novel therapeutic target in patients with heart failure (HF). Anemia is common in HF patients, with a prevalence ranging from 4% to 55% depending on the population studied. Multiple potential mechanisms of interaction exist between anemia and the clinical syndrome of HF, including hemodilution, inflammatory activation, renal insufficiency, and malnutrition.”

Anemia and heart failure

O'Meara E et al. Heart Fail Rep. 2004 Dec;1(4):176-82.

“Over the past few years, anemia has emerged as a powerful independent predictor of adverse outcomes in chronic heart failure (CHF). It affects up to 50% of patients with CHF, depending on the definition of anemia used and on the population studied. Even small reductions in hemoglobin are associated with worse outcome.”

Created By
Michael Collan MediTec Group


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