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Iron Deficiency in Heart Failure — RACP Adult Medicine MCQ

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ModerateCardiologyIron Deficiency in Heart FailureRACP Adult Medicine

A 58-year-old man with iron deficiency anaemia and HFrEF (LVEF 30%) has a haemoglobin of 105 g/L, ferritin 80 µg/L, and transferrin saturation 15%. He is symptomatic with NYHA class III symptoms. According to the Australian heart failure consensus, what is the recommended treatment?

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Correct answer: D — IV ferric carboxymaltose

Iron deficiency (defined as ferritin <100 µg/L, or ferritin 100–299 µg/L with TSAT <20%) in HFrEF is associated with worse outcomes regardless of anaemia status. IV ferric carboxymaltose improves symptoms, exercise capacity, and quality of life (FAIR-HF, AFFIRM-AHF trials). It is recommended by the Australian heart failure consensus statement. Oral iron is poorly absorbed and insufficiently effective. IV iron is recommended even in the absence of anaemia if iron deficiency criteria are met.

Reference: NHF/CSANZ – 2022 – Heart Failure Consensus Statement; eTG – 2025 – Cardiovascular