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Heart failure with reduced ejection fraction — ABIM Board MCQ

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HardCardiovascularHeart failure with reduced ejection fractionABIM Board

A 59-year-old with stable symptomatic HFrEF has ferritin 72 ng/mL and transferrin saturation 16% despite no active bleeding. Hemoglobin is 11.8 g/dL and oral iron caused gastrointestinal intolerance. Which therapy best addresses the iron deficiency and functional limitation?

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Correct answer: E — Offer intravenous iron using an evidence-based formulation

The best answer is “Offer intravenous iron using an evidence-based formulation”. Heart-failure iron deficiency is defined by ferritin and transferrin saturation and can impair exercise capacity even without severe anemia. Intravenous iron improves functional status and quality of life and may reduce HF hospitalization. Oral absorption is often inadequate, transfusion is not iron-repletion therapy here, and erythropoiesis-stimulating agents add thrombotic risk without established benefit.

Reference: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063