ARTICLE IN PRESSJournal of Cardiac Failure Vol.00 No.00 2023Iron Deficiency in Heart Failure:A Scientific Statement fromthe Heart Failure Society of AmericaCRAIG J.BEAVERS,PharmD,Co-Chair,1 ANDREW P.AMBROSY,MD,2 JAVED BUTLER,MD,MPH,MBA,3.4BETH T.DAVIDSON,DNP,5 STORMI E.GALE,PharmD,5 ILEANA L.PINA,MD,MPH,?IOANNIS MASTORIS,MD,3NOSHEEN REZA,MD,ROBERT J.MENTZ,MD,10 AND GREGORY D.LEWIS,MD,Co-ChairLexington,Kentucky;Dallas,Texas;Jackson,Mississippi;Nashville,Tennessee;Matthews,and Durham,North Carolina;Philadelphia,Penn-sylvania;and Boston,MassachusettsABSTRACTIron deficiency is present in approximately 50%of patients with symptomatic heart failureand is independently associated with worse functional capacity,lower quality of,life andincreased mortality.The purpose of this document is to summarize current knowledge of howiron deficiency is defined in heart failure and its epidemiology and pathophysiology,as wellas pharmacological considerations for repletion strategies.This document also summarizesthe rapidly expanding array of clinical trial evidence informing when,how,and in whom toconsider iron repletion.Cardiac Fail 2023,00:1-19)Key Words:Heart failure,iron deficiency.Iron Deficiency:A Global Public Health Problem"looked healthier."Recognition of inadequate die-Although iron is naturally abundant environmen-tary iron intake across the spectrum of age andsocioeconomic status led to iron fortification of sta-tally,iron deficiency (ID)is among the most com-mon nutritional deficiencies worldwide.2 Althoughple foods.In patients with symptomatic heart failureprehistoric skeletal remains have revealed findings(HF)the prevalence of ID is approximately 50%consistent with prevalent ID,3 it was not until 1928based on the current definition of ID used in HF clini-that Helen Mackay observed that infants with lim-cal trials and ID independently predicts mortality.5.6ited nutrition given supplemental iron salts experi-Thus,ID represents a longstanding global publicenced less postnatal hypochromic anemia andhealth problem that poses a particularly high bur-den in patients with HF.?From the 'University of Kentucky College of Pharmacy,Lexing-ton,Kentucky;Kaiser Permanente Northem Califomia-Divisionof Research (DOR),Oakland,CA:Baylor Scott and WhiteOperational Definition of IDResearch Institute,Dallas,Texas;4University of Mississippi,Jack-son,Mississippi:Centennial Heart Cardiovascular Consultants,Iron exists in aqueous solution as ionized cytotoxicNashville,Tennessee;Novant Health Matthews Medical Center,Matthews,North Carolina:Thomas Jefferson University,Phila-free radicals capable of causing oxidative injury anddelphia,Pennsylvania:Massachusetts General Hospital,Boston,premature cell death and by necessity must beMassachusetts;Division of Cardiovascular Medicine,Perelmanstored and transported throughout the body as pro-School of Medicine at the University of Pennsylvania,Philadel-phia,Pennsylvania and 1Duke University School of Medicine,tein-iron complexes.39 Most
