1) Iron deficiency is a common but often unrecognized and undertreated comorbidity in patients with heart failure.
2) Iron deficiency is prevalent in around 76% of Indian patients with heart failure and is associated with increased morbidity and mortality as well as worse patient outcomes and quality of life.
3) Intravenous ferric carboxymaltose is recommended for treating iron deficiency in heart failure patients, as it is more effective than oral iron supplements which are poorly absorbed and do not adequately address the underlying causes of restricted iron availability.
Iron Deficiency : An Overlooked Aspect of Heart Failure Managementmagdy elmasry
Iron deficiency: a comorbidity that goes unnoticed in heart failure.Optimization of heart failure treatment.
Types of iron deficiency.Absolute ID &Functional ID.Iron Deficiency in Heart Failure :
A Therapeutic Target
Iron therapy for the treatment of iron deficiency
in chronic heart failure: intravenous or oral?
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Iron Deficiency : An Overlooked Aspect of Heart Failure Managementmagdy elmasry
Iron deficiency: a comorbidity that goes unnoticed in heart failure.Optimization of heart failure treatment.
Types of iron deficiency.Absolute ID &Functional ID.Iron Deficiency in Heart Failure :
A Therapeutic Target
Iron therapy for the treatment of iron deficiency
in chronic heart failure: intravenous or oral?
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
ARNI as new standard of care in Heart Failure SYEDRAZA56411
Angiotensin Receptor Blocker -Neprilysin Inhibitor combination has an important role to play in patients with Heart Failure with reduced ejection fraction. ARNI is now first line medication in HRrEF
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
ARNI as new standard of care in Heart Failure SYEDRAZA56411
Angiotensin Receptor Blocker -Neprilysin Inhibitor combination has an important role to play in patients with Heart Failure with reduced ejection fraction. ARNI is now first line medication in HRrEF
Rolla Abu-Arja, clinical director of pediatric bone marrow transplant in Nationwide Children's Hospital (Columbus, OH) discusses iron overload in hematopoetic cell transplantation.
Iron deficiency is an extremely common comorbidity in patients with heart failure, affecting up to 50% of all ambulatory patients. It is associated with reduced exercise capacity and physical well-being and reduced quality of life. Cutoff values have been identified for diagnosing iron deficiency in heart failure with reduced ejection fraction as serum ferritin, <100 μg/l, or ferritin, 100 to 300 μg/l, with transferrin saturation of <20%. Oral iron products have been shown to have little efficacy in heart failure, where the preference is intravenous iron products. Most clinical studies have been performed using ferric carboxymaltose with good efficacy in terms of improvements in 6-min walk test distance, peak oxygen consumption, quality of life, and improvements in New York Heart Association functional class. Data from meta-analyses also suggest beneficial effects for hospitalization rates for heart failure and reduction in cardiovascular mortality rates. A prospective trial to investigate effects on morbidity and mortality is currently ongoing. This paper highlights current knowledge of the pathophysiology of iron deficiency in heart failure, its prevalence and clinical impact, and its possible treatment options
This is a comprehensive review of the physiology and pathophysiology of iron deficiency anemia and the evolution of its treatment with parenteral iron to the current recommendations. In our practice, in an attempt to minimize allogenic blood transfusions, we optimize preoperatively patients with iron deficiency anemia by means if intravenous iron replacement.
Atrioventricular blocks are related to delay in conduction of the AV node..
Their recognition is primarily by ECG, anatomical correlation is by EP study.
ST elevation is not always due to STEMI. Other causes to be kept in mind to prevent the undue complications of thrombolysis. wrong patient and wrong management
The electrocardiogram, a basic tool in cardiology has been developed two centuries ago. It was recorded by a giant machine at that time, which is now being recorded on a mobile. Such is the advancement in ECG, which is still the gold standard in diagnosis of VT .
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Model Attribute Check Company Auto PropertyCeline George
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This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
1. Iron deficiency in Heart failure:
Most Common,
Unrecognised
&
Undertreated Comorbidity
Dr. Nagula Praveen, MD, DM
Assistant Professor of Cardiology
Osmania General Hospital, Hyderabad
drpraveennagula@gmail.com
@kizashipraveen
2. The burden of Heart Failure is increasing
at an alarming rate in India.
Prevalence of HF ranges from 13 to 46 lakhs, with an
annual incidence of 5 -18 lakhs1.
*Parameters India US & Europe
Age 53 yrs 65 - 75
EF 29.2% 34.4-39%
Death 30.8% 4-7%
Re-hospitalization 39.5% 24 -31%
Death post discharge 26.3% 5-15%
‘23% Heart failure
patients die within a
year of diagnosis’
INTER-CHF study
Patients with Heart Failure in India
Affected at a Younger Age
High Morbidity and Mortality and worsens the patient’s quality
of life - in hospital and after discharge
S. Mishra et al. Indian Heart Journal 70 (2018) 105–127
5. Depletion of iron available in the circulation (bound to transferrin) and iron stores (ferritin in the liver and iron in the RES)
Depletion of iron available in the circulation (bound to transferrin) but not iron stores
Types of Iron Deficiency
Reduced iron storage
Reduced iron mobilization
7. Role of Hepcidin
Hepcidin is a hormone produced by
the liver.
Hepcidin functions to regulate (inhibit)
iron transport across the gut mucosa
macrophages
In states of high hepcidin levels
(including inflammatory states like in
chronic disease), serum iron levels
can drop because iron is trapped
inside macrophages
Plasma
Fe-Tf
Spleen
Bone
marrow
RBC
Liver
Duodenum
Inflammation
Nemeth E, et al. Blood. 2003;101:2461-2463.
Nemeth E, et al. J Clin Invest. 2004;113:1271-1276.
Courtesy of Tomas Ganz, PhD, MD, and Elizabeta Nemeth, MD.
12. Dealing with comorbidities in heart failure
Iron deficiency is an important comorbidity and is
prevalent in patients with heart failure ;
however, it is often neglected.
Iron deficiency:
A comorbidity that goes
unnoticed in heart failure
13. Iron Deficiency is common in patients with HF
8-10 Mn Individuals
are affected by Heart
Failure in India 1
1 - Chaturvedi et al Heart failure in India. The Indus Study
6-8 Mn Iron Deficiency
in CHF patients in India 2
3 out of 4
Heart failure
patients have
ID in India
Country wise ID prevalence in HF
USA
61.3%
Europe
37-50 %
Singapore
61.4 %
Singapore Indian
82 %
S.K. Sharma et.al. Indian Heart J. 2016 Jul-Aug; 68(4): 493–497.
Alarming burden of ID with HF in India
Up to 50% of patient with HF have concomitant Iron Deficiency
14.
15. Iron Deficiency is associated with increased
Mortality in Acute HF
Survival amongst 165 acute HF Patients by iron status
sTfR - serum soluble transferrin receptor European Heart Journal (2014) 35, 2468–2476
Both low hepcidin and high sTfR predicted higher 12-month mortality rates in patients with AHF.
18. 2016 ESC guidelines for the diagnosis and treatment of HF -
In these guidelines
Iron Deficiency is defined as follows:
Serum ferritin <100 µg/L
(absolute iron deficiency),
or
Serum ferritin 100–299 µg/L and
“transferrin saturation” TSAT <20%
(functional iron deficiency).
19. All patients with HF are recommended to be screened for
iron deficiency based on serum ferritin and TSAT
21. Adapted from: Beard JL. J Nutr 2001;131:568S–79S.
Challenges in the Diagnosis of Iron Deficiency
Despite ESC Guidelines
- Stating that Iron Deficiency is a common comorbidity in patients with
Heart Failure
- Recommending regular screening and assessment
Lack of Awareness of Iron
Deficiency by clinicians
25. Parameters for the assessment of Iron Status
MCV - mean corpuscular volume
Zinc Protoporphyrin(ZPP) - ZPP is used as a screening marker of iron deficiency in individual pregnant women and children, but also to
assess population iron status in combination with haemoglobin concentration.
sTfR - serum soluble transferrin receptor
Hb MCV Ferritin TSAT ZPP sTFR
ID N N N N N
ID Erythropoiesis N N
IDA N or
FID N or N or
ACD N or N or N or N or
ACD + ID N or N or (or N?)
28. ID is common in Patients with HF regardless of the presence
of Anemia
29. ID with or without Anemia
Peak oxygen consumption
(–) anaemia
(–) ID
(+) anaemia
(–) ID
(–) anaemia
(+) ID
(+) anaemia
(+) ID
Iron deficiencyp<0.001
Anaemia p=0.15
Interactions p=0.94
17
16
15
PeakVO2(mL/min/kg)
14
13
12
Klip IT et al. Am Heart J 2013;165:575–82.
ID defined as: serum ferritin <100 μg/L, or serum ferritin 100–299 μg/L with TSAT <20%.
Anaemia defined as: haemoglobin level <12 g/dL in women and <13 g/dL in men.
No ID
No anaemia
No ID
Anaemia
ID
No anaemia
ID
Anaemia
HR(95%CI)forall-causemortality
30. Myocardial iron content is reduced in advanced heart failure
300
250
200
150
100
50
p<0.001
MyocardialIron
[µg/gdryweight]
Myocardial Iron content
A comparison of the myocardial iron content in explanted hearts of patients
with advanced HF versus normal donor hearts as control
Iron content was significantly reduced in
advanced HF compared with the controls
This may worsen mitochondrial function
• Melenovsky V et al. Eur J Heart Fail 2017;19:522–30
31. IRON MATTERS FOR CONTRACTILITY
Contractility is impaired in iron deficient cardiomyocytes and can be improved
with iron
Iron deficiency reduced contractile force by 43% (P<0.05)
Subsequent addition of transferrin-bound iron could reverse this effect
Myocardial contractility
Adapted from Hoes et al. 2018
100
6
99
98
97
96
95
543210
Time (s)
Fractionareal(%)
Control
4 days iron deficient
4 days Iron deficient + transferrin-bound iron
Control cardiomyocytes
Iron deficient cardiomyocytes
In vitro model using human embryonic stem cell-derived cardiomyocytes made
profoundly iron deficient by the administration of the iron chelator deferoxamine (DFO) • Hoes MF et al. Eur J Heart Fail. 2018;20:910-919
32. Iron deficiency in heart failure
Clinical question
• Is intravenous iron more effective than oral iron for the treatment of
iron deficiency in patients with heart failure ?
Iron therapy for the treatment of iron deficiency in chronic heart
failure: intravenous or oral ?
33. • In FAIR-HF, 459 iron deficient CHF patients
were randomized to i.v. ferric carboxymaltose or
saline and assessed at 4, 12, and 24 weeks.
• At 4 weeks, FCM was associated with greater
reductions in weight (0.02) and PVS (P <
0.0001), and a trend for improved peripheral
oedema at 24 weeks (0.07).
• Irrespective of treatment allocation, patients with
a decrease in PVS from baseline to week 24
had higher increments in 6 min walking distance
(61.4 m vs. 43.5 m, 0.02) and were more likely
to improve their NYHA class (33.3% vs. 15.5%,
0.001).
ESC Heart Fail 2019 Aug; 6(4): 621–628
Change in markers of congestion in FAIR-HF
Alterations from baseline to week 24
Effect of ferric carboxymaltose on calculated plasma
volume status and clinical congestion: a FAIR-HF substudy
34. A PVS > - 4% at baseline predicted worse outcomes even
after adjustment for treatment assignment (hazard ratio
1.88, 95% confidence interval 1.01–3.51, 0.046).
Baseline PVS categories (≤-4% vs. >-4%)
and survival
• IV iron therapy with FCM is associated with
reductions in PVS and weight even as early
as 4 weeks after treatment initiation.
• This supports a potential decongestive
effect of IV iron therapy in CHF that might be
one mechanism via which iron repletion
improves symptoms, quality of life, and
exercise performance in this population.
• Calculated PVS, a simple novel marker of
fluid overload, predicted deaths and
hospitalizations in the FAIR-HF cohort
irrespective of treatment assignment.
ESC Heart Fail 2019 Aug; 6(4): 621–628
Effect of ferric carboxymaltose on calculated plasma
volume status and clinical congestion: a FAIR-HF substudy
35. • Poorly tolerated
• GI absorption impaired , standard doses often insufficient
• Drug interactions
• Hepcidin issues
- Increased hepcidin levels, typical in inflammatory states such as HF ,
precludes resorption of iron from the gut
- High levels of hepcidin can “TRAP” iron in storage cells
Iron therapy for the treatment of iron deficiency
in chronic heart failure: intravenous or oral?
Oral therapy is not so effective
36. Effect of oral or i.v. iron therapy on ‘hepcidin block’ of iron release
from macrophages.
(A) Under normal circumstances,
∼25 mg of stored iron per day is
transported out of macrophages to
plasma transferrin by the iron transporter
protein ferroportin.
(B) In chronic disease, elevated levels of
hepcidin cause degradation of
ferroportin, restricting ferroportinmediated
transport to ∼15 mg iron/day
37. Effect of oral or i.v. iron therapy on ‘hepcidin block’ of iron release
from macrophages.
(C) Oral iron The rate of iron
absorption from iron therapy is
inadequate to influence this ‘hepcidin
block’.
(D) I.V. iron therapy results in high
intracellular iron levels which overcome
the ‘hepcidin block’ by stimulating
overexpression of ferroportin
38. Oral iron of no benefit in HF with ID
Conclusions and Relevance Among participants with HFrEF with iron
deficiency, high-dose oral iron did not improve exercise capacity over 16 weeks.
These results do not support use of oral iron supplementation in patients
with HFrEF.
39.
40. 1. CosmoFer Summary of Product Characteristics. Vitaline Pharma UK. Last updated August 2007
2. Ferrlecit Summary of Product Characteristics. Rhone-Poulenc-Rorer, Dagenham, UK. Last updated July 1996
3. Venofer Summary of Product Characteristics. Syner-Med (Pharmaceutical Products) Ltd, UK. Last updated August 2006
4. Feraheme Summary of Product Characteristics. AMAG Pharmaceuticals, Inc, Lexington, MA, USA. June 2009
5. Ferinject Summary of Product Characteristics. Syner-Med (Pharmaceutical Products) Ltd. Last updated July 2007
Maximum single
dose(mg iron)
Administration
time by drip
infusion for
maximum
single dose**
Test dose
required?
20mg/kg
Yes
62.5mg
Max 125mg
-
4-6 hours
30 min
for 62.5 mg
200mg*
4mg/kg
Yes/No***
30 min
1000mg
or 15mg/kg
-
15 min
(Infusion and
injection)
Iron dextran Iron
gluconate
Iron
sucrose
Ferric
carboxymaltose
* Maximum dose of 500mg iron can be administered in some countries
** Except for Feraheme®
***Depending on the country
510mg
-
Ferumoxytol
17 seconds
(i.v. injection
only)
Ferric Carboxymaltose has added advantage over the other IV formulation.
Evidence-Based Answer - Ferric Carboxymaltose is preferred agent
(other preparations not as well studied)
IV iron is the only valid treatment option for ID in HF
41. Clinical Evidences of IV Ferric Carboxymaltose Therapy in HF
FER-CARS-01 META-ANALYSIS
Arutyunov et al.
2009– HFA
Congress, Nice,
France
Anker S. et al.
2009 – NEJM)
Ponikowski P.
et al. 2014 -
European
Heart Journal
Anker S. et al.
2015 - ESC
Congress,
Seville, Spain
Van Veldhuisen
DJ et al. 2016-
AHA Congress,
New Orleans,
USA
42. FCM, ferric carboxymaltose
Meta-analysis on individual patient data with FCM:
Efficacy outcomes
Rate ratio analysis (recurrent event analyses)
Recurrent event outcomes
FCM
(N=504)
Placebo (N=335) Rate Ratio (95%CI) p
CV hospitalisation and CV death 69 (23.0) 92 (40.9) 0.59 (0.40-0.88) 0.009
HF hospitalisation and CV death 39 (13.0) 60 (26.7) 0.53 (0.33-0.86) 0.011
CV hospitalisation and all-cause death 71 (23.7) 94 (41.8) 0.60 (0.41-0.88) 0.009
HF hospitalisation and all-cause death 41 (13.7) 62 (27.6) 0.54 (0.34-0.87) 0.011
All-cause hospitalisation and
all-cause death
108 (36.1) 118 (52.5) 0.73 (0.52-1.01) 0.060
HF hospitalisation 22 (7.3) 43 (19.1) 0.41 (0.23-0.73) 0.003
CV hospitalisation 52 (17.4) 75 (33.3) 0.54 (0.36-0.83) 0.004
All-cause hospitalisation 89 (29.7) 99 (44.0) 0.71 (0.50-1.01) 0.056
Anker SD et al. Eur J Heart Failure 2017
43. • Ferric carboxymaltose
improves functional capacity,
symptoms, and quality of life
of HF patients with iron
deficiency.
• A meta-analysis of data from
the four major randomized
controlled trials conducted,
to date, demonstrated also a
reduction in recurrent CV
hospitalizations.
December 2019: ESC Heart Failure
44. Ongoing clinical trials addressing gaps in evidence
Morbidity and Mortality in HFrEF HFpEF AHF
45. Key Home message
Iron deficiency
an important comorbidity and is prevalent in patients with heart failure however it is
often neglected.
Observed in almost 76% of Heart Failure Indian patients.
prevalent in chronic heart failure (also in non-anaemics)
relates to a reduced exercise tolerance and impaired quality of Life
associated with substantially higher Mortality Risk
directly affects Cardiomyocytes function, Impairing mitochondria respiration and
reducing contractility
Treatment with Ferric Carboxymaltose improves Morbidity & Mortality in patients with
HF and iron deficiency
46. Future Direction - Iron deficiency is an important
comorbidity and is prevalent also in patients with
HFpEF & AHF, however it is often neglected.
Editor's Notes
10 Pivotal issues about Heart Failure with Reduced EF
mean corpuscular volume (MCV) and the mean corpuscular hemoglobin concentration (MCHC).
Zinc Protoporphyrin -ZPP is used as a screening marker of iron deficiency in individual pregnant women and children, but also to assess population iron status in combination with haemoglobin concentration.