Anemia is a highly prevalent comorbidity in heart failure (HF) patients and represents both a marker of HF severity and a predictor of poor prognosis. Anemia is per se associated with impaired exercise performance and functional capacity. Iron deficiency (ID) is an important comorbidity of HF, but the diagnosis and correction of ID remain largely unrecognized in the cardiology community. And, although anemia and ID both have "global" detrimental effects, these 2 conditions are too often overlooked in cardiology daily clinical practice.
The presence of ID, irrespective of Hb levels, has been associated with a reduced peak oxygen uptake and an increased ventilation versus carbon dioxide production slope in patients with HF. Large randomized trials strongly support intravenous (IV) iron administration, a beneficial therapeutic strategy to be adopted in HF patients with ID, and guidelines also recommend IV iron replacement therapy in the HF patients who meet the ID criteria.
The present review sought to summarize briefly the prevalence and the underlying pathophysiologic mechanisms of anemia and ID as regards HF severity (ie, exercise capacity) and prognosis.