Is iron therapy indicated for heart failure with reduced ejection fraction patients?

Patients with heart failure and reduced ejection fraction are often iron deficient in part due to the inflammatory nature of heart failure that limits iron absorption. Not surprisingly, these patients are often also anemic. The role of iron replacement in heart failure has been the subject of multiple investigations, in part triggered by the availability of newer, safer, parenteral iron preparations. Specifically, ferric carboxymaltose and ferric derisomaltose have been utilized in multiple heart failure trials. Additionally, there have been several smaller trials using oral iron salts in heart failure. This review investigates the role of iron supplementation in patients with heart failure and reduced ejection fraction including the provision of recommendations based on review of available evidence and consensus statements.