ABSTRACT
Anemia and iron deficiency are highly prevalent comorbidities in patients with heart failure. Both are associated with significant morbidity and mortality, including reduced quality of life, poor exercise tolerance, and more frequent heart failure-related hospitalizations. The etiology and pathophysiology of anemia and iron deficiency in patients with heart failure are still not fully understood but are partly related to the systemic consequences of heart failure itself, including inflammation, renal disease, fluid retention, and malnutrition. This chapter focuses on the different aspects of anemia and iron deficiency in patients with heart failure, including etiology, pathophysiology, clinical consequences, and diagnostic work-up. Moreover, therapeutic approaches for anemia and iron deficiency in these patients are discussed, including novel strategies. Erythropoietic-stimulating agents are not recommended for the treatment of anemia in patients with heart failure, as these agents have neutral effects on prognosis and increase risk of thromboembolic events. Instead, treatable causes of anemia should be identified and treated. Intravenous iron can be administered to improve symptoms, exercise tolerance, and quality of life in symptomatic patients with heart failure and iron deficiency. The potential prognostic benefit of this treatment modality is still being actively evaluated.
