Intravenous iron

Iron deficiency is common in patients with heart failure. Read more.

In the meantime, this has also become a therapeutic target.

Therapy

Heart failure causes gastrointestinal malabsorption of iron. This makes peroral substitution not useful. Taking peroral iron supplements has been tested in a large clinical heart failure study, but could not demonstrate any added value. Intravenous administration of iron is efficient.
The quality of life, exercise capacity and reduces symptoms and short-term hospitalizations due to heart failure in HFrEF patients, regardless of the degree of anemia. However, positive effects on mortality and hospitalizations have not yet been demonstrated in the longer term and are being further investigated.
With HFmrEF and HFpEF there is no proven benefit and no reimbursement for intravenous correction of iron deficiency. This may be considered in certain cases.

- Maximum dose per administration is 1000 mg IV. Sometimes the total dose must be divided into 2 administrations, with a minimum of 1 week between 2 administrations.
- Rapid administration is possible over 30 minutes.
- Little risk of allergic reactions.
- Possible side effect: transient hypophosphatemia (for several weeks, especially after more than 1 administration). If more pronounced it can cause symptoms of fatigue, muscle cramps, constipation, nausea, bone pain and osteomalacia.
- Dosage schedule:

- Advantage: the entire required intravenous dose can be administered in one go.
- Much less occurrence of hypophosphatemia afterwards than with Injectafer .
- Monoferric has been less studied in heart failure patients.

Reimbursement is possible in Belgium since 2021 for heart failure with reduced LVEF (HFrEF) if these criteria are met:

NYHA class II-IV.
Iron deficiency according to the definition above.
LVEF ≤ 40%.
The iron deficiency was investigated for all potentially treatable / reversible causes.

This reimbursement must be requested electronically by a cardiologist.