Background: Iron deficiency is a comorbidity associated with heart failure as a result of increased circulating inflammatory cytokines. The 2017 ACC/AHA heart failure (HF) guidelines gives a Class IIB recommendation for use of intravenous (IV) iron in HF patients with NYHA functional class II or III symptoms and iron deficiency. Currently at our institution, there is no protocol to guide the dosing of ferric gluconate. We generally replete patients with IV iron for a total dose of 1 gram.

Aims: To evaluate the prescribing patterns and safety of IV ferric gluconate in iron deficient patients admitted with HF exacerbations.

Methods: This is a retrospective cohort study of all patients > 18 years of age with a HF diagnosis that received ferric gluconate between Jan 2019 and July 2021 at NYU Langone Health. The primary outcome was assessment of ferric gluconate based on anemia characteristics of HF patients. Secondary outcomes included tolerability, safety, blood transfusions, and hospital readmission within 30 days.

Results: Eighty-one patients received IV ferric gluconate, with the majority of patients with HF with a LVEF < 30% (40%), NYHA functional class III (58%), and a history of anemia (54%). Most patients were on concomitant anticoagulants. Adverse events were rare. Hospital readmissions for HF exacerbations within 30 days were infrequent at 8%. Blood transfusions within 2 weeks of IV iron administration occurred in 24% of patients.

Conclusion(s): Overall, IV iron repletion can be considered a safe and tolerable method for managing anemia in HF. Patients on anticoagulant therapy may benefit from IV iron repletion. Based on tolerability, and early patient disposition, updating local practices to 250mg IV ferric gluconate twice daily for 2 days may replenish iron stores sooner than 125mg IV ferric gluconate daily.  However, this may lead to increased drug cost, without an impact on hospital readmissions, and should be evaluated further.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/intravenous-ferric-gluconate-use-in-anemic-heart-failure-patients-at-a-large-academic-medical-center/