skip to main content

IV Iron in Heart Failure — EECC MCQ

Instant feedback + full explanation. One question, done properly.

EasyHeart FailureIV Iron in Heart FailureEECC

A 72-year-old man with HFrEF (LVEF 25%) has a haemoglobin of 95 g/L with an MCV of 82 fL. His iron studies show ferritin 35 microg/L and TSAT 14%. eGFR is 50 mL/min/1.73 m². What is the recommended treatment for the iron deficiency?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intravenous ferric carboxymaltose

Iron deficiency in HF is defined as ferritin <100 microg/L, or ferritin 100-299 microg/L with TSAT <20%. This patient meets criteria (ferritin 35, TSAT 14%). The ESC HF Guidelines recommend intravenous iron replacement (ferric carboxymaltose or ferric derisomaltose) to improve symptoms, exercise capacity, and quality of life (Class I, LOE A for symptom improvement). The IRONMAN and AFFIRM-AHF trials support IV iron. Oral iron is poorly absorbed in HF (due to intestinal oedema, elevated hepcidin) and is not recommended. ESAs are not beneficial in HF (RED-HF trial showed no benefit with increased thromboembolic risk).

Reference: ESC (2023): Focused Update on Heart Failure