IV Iron FAIR-HF Evidence — EECC MCQ

Correct answer: A — The FAIR-HF and CONFIRM-HF trials showed IV iron (ferric carboxymaltose) improves symptoms, exercise capacity (6MWD), and quality of life in HFrEF with iron deficiency — this benefit occurs regardless of whether anaemia is present; the ESC gives IV iron a Class I recommendation

Iron deficiency (ID) in HF is defined as ferritin <100 OR ferritin 100-299 with TSAT <20% — importantly, this definition does NOT require anaemia (Hb may be normal). ID occurs in 30-50% of HFrEF patients and independently worsens symptoms, exercise capacity, and prognosis. Evidence for IV iron: FAIR-HF (2009): IV FCM improved NYHA class, 6MWD, and patient-reported quality of life vs placebo (Class I evidence for symptom improvement). CONFIRM-HF (2015): sustained 6MWD improvement and reduced HF hospitalisation over 1 year. IRONMAN (2022): trend toward reduced HF hospitalisation (significant in pre-COVID analysis). The ESC 2023 HF Guidelines give IV iron a Class I, LOE A recommendation for symptom improvement. Oral iron is NOT recommended (IRONOUT-HF: no benefit — poor absorption in HF due to hepcidin elevation and intestinal oedema).

Reference: ESC (2023): HF Guidelines; FAIR-HF/CONFIRM-HF