Iron replacement therapy in heart failure: a literature review

The Egyptian Heart Journal

Table 2 Current guideline recommendations reagrding the use of intravenous iron in heart failure

Guideline group	Year of publication	Recommendation	Class/level of evidence
European Society of Cardiology [44]	2016	IV ferrous carboxymaltose should be considered in symptomatic patients with HFrEF and ID (ferritin < 100 µg/L, or ferritin 100–299 if TSAT < 20%)	IIa (weight of evidence is in favour of usefulness)/level A
American Heart Association/American College of Cardiology [47]	2016	In HF patients with NYHA class II and III and ID (ferritin < 100 ng/mL, or 100–300 ng/mL if TSAT < 20%), IV iron may be reasonable to improve functional status and quality of life	IIb (weak strength of recommendation)/ level B-R
Scottish Intercollegiate Guidelines Network [46]	2017	HFrEF patients with either NYHA class III and LVEF ≤ 45%; or NYHA class II and LVEF ≤ 40%, along with haemoglobin 9.5–13.5 g/dL should be considered for IV iron	1+ + + (high-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias)
National Institute for Health and Care Excellence [48]	2018	No recommendation

HF heart failure, HFrEF heart failure with reduced ejection fraction, IV intravenous, ID iron deficiency, TSAT transferrin saturation, NYHA New York Heart Association, LVEF left ventricular ejection fraction, RCT randomised controlled trial