Iron deficiency (ID) is present in approximately 50% of patients with heart failure (HF) and even higher prevalence rate up to 80% in post-acute HF setting. The current guidelines for HF recommend intravenous (IV) iron replacement in HF with reduced or mildly reduced ejection fraction and ID based on clinical trials showing improvements in quality of life and exercise capacity, and an overall treatment benefit for recurrent HF hospitalization. However, several barriers cause challenges in implementing IV iron supplementation in practice due, in part, to clinician knowledge gaps and limited resource availability to protocolize routine utilization in appropriate patients. Thus, the current review will discuss practical considerations in ID treatment, implementation of evidence-based ID treatment to improve regional health disparities with toolkits, inclusion/exclusion criteria of IV iron supplementation, and clinical controversies in ID treatment, as well as gaps in evidence and questions to be answered.

中文翻译：

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心力衰竭缺铁的管理：循证补铁的实际考虑和实施


大约 50% 的心力衰竭 （HF） 患者存在缺铁 （ID），急性 HF 后患者的患病率甚至更高，高达 80%。目前的 HF 指南推荐对射血分数和 ID 降低或轻度降低的 HF 患者进行静脉 （IV） 补铁，因为临床试验显示生活质量和运动能力得到改善，并且对复发性 HF 住院的总体治疗获益。然而，在实践中实施静脉补铁面临一些挑战，部分原因是临床医生的知识差距和资源可用性有限，无法在适当患者中进行常规使用。因此，本综述将讨论 ID 治疗的实际考虑、实施循证 ID 治疗以改善工具包的区域健康差异、静脉补铁的纳入/排除标准、ID 治疗的临床争议，以及证据差距和有待回答的问题。