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Eur J Heart Fail. 2018 Dec;20(12):1664-1672. doi: 10.1002/ejhf.1305. Epub 2018 Oct 12.

Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice.

Author information

King's College Hospital, London, UK.
Department of Cardiology, AP-HP, DHU A-TVB and GRC ARI, Henri Mondor University-Hospital, Créteil, France.
Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), and Center for Stroke Research Berlin and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin, Berlin, Germany.
National Heart Centre Singapore, Duke-National University of Singapore, Singapore; and Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Heart Failure Unit and Department of Cardiac Rehabilitation, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Cardiology, Paris Diderot University, Sorbonne Paris Centre, UMRS 942, Lariboisière Hospital, Paris, France.
Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), Saarland University Medical Center, Homburg/Saar, Germany.
Heart Failure and Transplant Unit, Department of Cardiology, Hospital de Bellvitge, Barcelona, Spain.
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Heart Centre, Kuopio University Hospital, Kuopio, Finland.
Department of Medicine for the Elderly, Glasgow Royal Infirmary, Glasgow, UK.
Community Heart Failure Program, Department of Cardiology, University of Barcelona, Bellvitge University Hospital and IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.


Iron deficiency is common in patients with chronic heart failure (CHF) and is associated with reduced exercise performance, impaired health-related quality of life and an increased risk of mortality, irrespective of whether or not anaemia is present. Iron deficiency is a serious but treatable condition. Several randomized controlled clinical trials have demonstrated the ability of intravenous (IV) iron, primarily IV ferric carboxymaltose (FCM), to correct iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF), resulting in improvements in exercise performance, CHF symptoms and health-related quality of life. The importance of addressing the issue of iron deficiency in patients with CHF is reflected in the 2016 European Society of Cardiology (ESC) heart failure guidelines, which recognize iron deficiency as an important co-morbidity, independent of anaemia. These guidelines recommend that all newly diagnosed heart failure patients are routinely tested for iron deficiency and that IV FCM should be considered as a treatment option in symptomatic patients with HFrEF and iron deficiency (serum ferritin < 100 µg/L, or ferritin 100-299 µg/L and transferrin saturation < 20%). Despite these specific recommendations, there is still a lack of practical, easy-to-follow advice on how to diagnose and treat iron deficiency in clinical practice. This article is intended to complement the current 2016 ESC heart failure guidelines by providing practical guidance to all health care professionals relating to the procedures for screening, diagnosis and treatment of iron deficiency in patients with CHF.


Chronic heart failure; European Society of Cardiology; Ferric carboxymaltose; Guidelines; Iron deficiency


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