Iron Deficiency Associated with Heart Failure

Iron deficiency (ID) is highly prevalent among individuals with heart failure (HF), impacting 40 to 70% of patients and serving as a significant prognostic indicator. Linked with oxidative metabolism and myocardial cell damage, ID exacerbates HF symptoms, including reduced exercise capacity, diminished quality of life, and heightened cardiovascular morbidity. This review explores the diagnosis, treatment, clinical outcomes, prognostic indicators, and forthcoming challenges associated with ID in HF patients. Crucially, addressing ID in HF is critical for enhancing prognosis, including clinical outcomes, quality of life, hospitalizations, and survival rates. While oral iron therapy shows efficacy in reducing mortality and hospitalizations, it falls short in improving exercise capacity and quality of life, often deterring patients due to adverse effects. In contrast, intravenous (IV) iron therapy demonstrates superior effectiveness in enhancing hematological parameters, and functional capacity, and reducing HF hospitalizations. Optimizing IV iron dosing based on individual patient characteristics is essential for balancing treatment efficacy and adverse effects. Emphasizing individualized approaches, with IV iron emerging as a superior option, underscores the necessity for ongoing research to refine dosing strategies and explore novel therapies. Addressing ID through tailored interventions, including oral or parenteral supplementation, is pivotal in averting complications and improving outcomes in HF patients.

State Boards of Nursing have varying positions on the role of the LPN/LVN in the administration of infusion therapy. A link to each state board of nursing is listed here. Competency requirements are obtained and maintained through the nurse’s employer, facility, or institution.

Objectives

Upon completion of this course, participants will be able to:

  1. Describe the relationship between heart failure and iron deficiency.
  2. Identify 3 parenteral iron preparations.
  3. Demonstrate understanding of parenteral iron administration by recognizing the steps involved in its administration.
  4. Recognize at least two potential complications of iron administration.

Curriculum

Chapter 1: Introduction

  • Relationship Between Heart Failure and Iron Deficiency
  • Guidelines for the Management of Heart Failure

Chapter 2: Iron Metabolism

  • Homeostatic Functions of Iron
  • Iron Regulation
  • Hepcidin
  • Ferritin
  • Transferrin
  • Total Iron Binding Capacity
  • Transferrin Saturation

Chapter 3: Causes of Iron Deficiency in Heart Failure

  • Absolute Iron Deficiency
  • Poor Nutrition
  • Decreased Iron Absorption
  • Gastrointestinal Bleeding
  • Hypercoagulation
  • Functional Iron Deficiency
  • Systemic Inflammation
  • Myocardial Iron Deficiency
  • Mitochondrial Dysfunction
  • Cardio-Renal Anemia Syndrome

Chapter 4: Parenteral Iron Preparations

  • Ferric carboxymaltose (Injectafer®)
  • Ferric derisomaltose (Monoferric®)
  • Ferric gluconate (Ferrlecit®)
  • Ferumoxytol (Feraheme®)
  • Iron sucrose (Venofer®)
  • Low molecular weight iron dextran (INFeD®)

Chapter 5: Conclusion

  • Administration
  • Hypersensitivity Reactions
  • Patient Education
  • Documentation

Chapter 6: References

  • Implicit Bias Mandate

Price: $24.00

Contact Hours: 2

Course Author

Pamela Clark

Pamela Clark, CRNI, is an infusion nurse with the Houston Methodist Sugar Land Hospital. She has more than 35 years of experience in infusion therapy and infusion education with both licensed nurses and patients. Her experience spans multiple infusion settings including: acute care, long-term care, home infusion, and ambulatory infusion care. She also has experience in oncology and oncology research.

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