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Iron Deficiency in HFrEF — EECC MCQ

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EasyHeart FailureIron Deficiency in HFrEFEECC

A 65-year-old woman with HFrEF (LVEF 32%) and iron deficiency (ferritin 65 microg/L, transferrin saturation 15%) but haemoglobin of 125 g/L is NYHA class III. She is on optimal quadruple medical therapy. What is the recommended treatment for her iron deficiency?

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Correct answer: B — Intravenous ferric carboxymaltose

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

Per the 2023 ESC Focused Update, intravenous iron supplementation (ferric carboxymaltose or ferric derisomaltose) is recommended in symptomatic patients with HFrEF/HFmrEF and iron deficiency (ferritin below 100 microg/L or ferritin 100-299 microg/L with TSAT below 20%) to improve symptoms and quality of life (Class I, LOE A), regardless of haemoglobin level. Oral iron (A) has shown inferior efficacy. Waiting for anaemia (C) misses the symptomatic benefit. ESAs (D) are not recommended. Transfusion (E) is not indicated with normal haemoglobin.

Reference: ESC (2023): Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure