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General Medicine
Should oral iron be dismissed in patients with heart failure?
  1. Miguel Angel De Las Nieves
  1. Haematology, Instituto Nacional de Gestion Sanitaria, Melilla, Spain
  1. Correspondence to Dr Miguel Angel De Las Nieves, Haematology, Instituto Nacional de Gestion Sanitaria, Melilla 52003, Spain; marbelhem{at}telefonica.net

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Heart failure (HF) affects between 1% and 2% of the population in western countries, and coronary artery disease is the main determinant in those cases with reduced ejection fraction.1 Iron deficiency (ID), a common comorbidity in these patients, is an independent negative predictor of functional capacity and survival.2

In normal conditions, haemoglobin (Hb) contains the largest amount of body iron, and Hb catabolism provides 95% of daily iron supply to tissues (25±5 mg).3 Therefore, normal Hb is the primary marker of iron status in an individual and the best guarantee of tissue iron delivery; however, Hb values for anaemia definition worldwide (Hb <120 g/L in females and <130 g/L in males) are far lower than normal mean values in first-world countries (Hb=136 g/L and 150 g/L in females and males, respectively).4

Transferrin saturation (TSAT) <20% with ferritin up to 300 ng/mL or any ferritin <100 ng/mL is being proposed as an indicator for ID diagnosis in HF, independent of Hb, comorbidity, inflammatory markers or gender2 5 6; intravenous iron is a class IIa and IIb recommendation in European and US guidelines, respectively.7 8 This recommendation is based on evidence from trials using this ID definition, showing that patient with systolic HF benefit …

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