Testing rates for iron deficiency in HF are low in real-world population

Testing for iron deficiency and use of ferric carboxymaltose in patients with heart failure: Need for implementation? Data from the Swedish heart failure registry

News - June 29, 2021

Presented at ESC Heart Failure 2021 by Peter Moritz Becher, MD (Hamburg, Germany)

Introduction and methods

Iron deficiency (ID) is associated with poor prognosis in HF, independently of anemia. IV iron can improve outcomes and quality of life in patients with HFrEF. However, little is known about the frequency of ID testing in clinical practice.

This study used data from the Swedish heart failure registry to assess the frequency of ID testing, prevalence of anemia and ID, and use of ferric carboxymaltose (FCM) in a real-world population across the entire ejection fraction spectrum.

Main results

  • Of a total of 21,496 patients with HF, 27% were tested for ID. Of these patients tested for ID, 57% had HFrEF, 24% had HFmrEF and 19% had HFpEF.
  • Independent predictors of ID testing included more symptomatic HF (higher NYHA class and use of diuretics), anemia, use of beta-blockers and follow-up to HF specialty care. Patients with HFrEF were more likely to be tested for ID followed by patients with HFmrEF and patients with HFpEF.
  • In the overall HF population tested for ID, 29% had ID, but no anemia and 20% of patients had ID and anemia.
  • In the overall HF population with ID, only 19% of patients received FCM.
  • Independent predictors of FCM use included more severe HF (higher NYHA class and MRA use), lower hemoglobin levels, diabetes and follow-up to HF specialty care. Use of FCM was more likely in patients with HFrEF followed by HFmrEF and HFpEF.


In a nation-wide HF registry, ID testing was performed in 27% of patients. 19% Of patients with HF and ID received FCM. A major determined for insufficient testing and treatment was the absence of concomitant anemia.


The discussant Prof. Davor Milicic (Zagreb, Croatia) referred to the 2021 ESC/HFA heart failure guidelines that were partially presented at the virtual ESC HF Congress today. New in these guidelines is the recommendation to periodically test all HF patients for ID. Prof. Milicic said that from today there is no excuse for not testing patients with HF for ID.

-Our reporting is based on the information provided at the ESC Heart Failure 2021 congress-

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