Iron Deficiency in Heart Failure Pathophysiology: Chronic heart failure leads to an increase in

Iron Deficiency in Heart Failure - Diagnosis and Treatment Algorithm Diagnosis: Ferritin <100 ng/mL (absolute ID) OR Ferritin 100-299 ng/mL with TSAT <20% (functional ID) Guidelines: • ACC/AHA 2017 - In patients with NYHA class II and Ill HF with iron deficiency, IV iron replacement might be reasonable to improve functional status and QOL (class IIb) • ESC 2016 - IV ferric carboxymaltose should be considered in symptomatic patients with HFrEF and iron deficiency in order to alleviate symptoms, and improve exercise capacity and QOL (class IIa) Alissa Shega, PharmD @alissa_shega #iron #deficiency #CHF #HFrEF #heartfailure #diagnosis #management #algorithm #cardiology #treatment #guidelines

Iron Deficiency in Congestive Heart Failure (CHF) Iron deficiency (ID) in heart failure is a common comorbidity affecting up to 50% of patients, leading to: ↑ HF Hospitalization ↓ Quality of life and hospitalizations survival ↓ Exercise capacity Diagnosis: • Ferritin < 100 ng/mL OR Ferritin 100 - 299 ng/mL + TSAT < 20% Risk Factors: • Female sex • More advanced stages of HF • Higher NT-proBNP and CRP Ganzoni Equation: Iron deficit (mg) = [body weight (kg) x (target Hgb — actual Hgb) x 2.4 + depot iron] Treatment Options (IV Iron Preferred) • Ferric carboxymaltose - 750 mg • Ferric gluconate - 125-150 mg • Ferumoxytol - 510 mg • Iron dextran - 100 mg • Iron sucrose - 100-200 mg By Kyle Fischer, PharmD @Kfischer_10 #Iron #Deficiency #Heart #Failure #CHF #pharmacology #pathophysiology #cardiology

$Algorithm for screening/diagnosis and treatment/follow‐up of iron deficiency in patients with chronic heart failure. Hb, haemoglobin;$

Algorithm for screening/diagnosis and treatment/follow‐up of iron deficiency in patients with chronic heart failure. Hb, haemoglobin; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; NYHA, New York Heart Association; TSAT, transferrin saturation #Iron #Deficiency #Management #Diagnosis #HFrEF #sCHF #HeartFailure #Cardiology #Indications #Treatment

Diagnostic Algorithm for Treatment of Iron Deficiency in Patients With Heart Failure Consensus Recommendations #Iron #Deficiency #Management #Diagnosis #Algorithm #HFrEF #sCHF #HeartFailure #Indications #Treatment

Iron Deficiency Anemia (IDA) Tests: • MCV/RBC - RBC ↓ in proportion to the ↓ in hemoglobin • Hemoglobin - O2 carrying component of blood • Iron - Amount available for Hemoglobin synthesis • TIBC - Amount of Iron to which transferrin is capable of binding • TSAT (Iron/TIBC X 100%) - Amount immediately available for hemoglobin synthesis • Ferritin - Indirect measure of total body iron stores Satyendra Dhar, MD @DharSaty #Iron #Deficiency #Anemia #IDA #ferritin #Fe #diagnosis #hematology

$Congestive Heart Failure - Causes, Pathophysiology and Differential Diagnosis • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy$

Congestive Heart Failure - Causes, Pathophysiology and Differential Diagnosis • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy • Restrictive Cardiomyopathy HFrEF Causes: • Cardiovascular • Toxic • Infectious • Other HFpEF Causes: • Afterload • Valvular • Infiltrative • Genetic • Other Dr. Jorge Cortés @Jcortesizaguirr #Congestive #HeartFailure #Causes #Pathophysiology #Differential #Diagnosis #cardiology #HFrEF #HFpEF #CHF

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America #HFrEF #HeartFailure #Management #CHF #guideline #ACCAHA2017 #cardiology #treatment #algorithm #sCHF

Acute Heart Failure Exacerbation - Diagnostic Likelihood Ratios +LR > 3.5: • Overall judgement of ED physician • History of heart failure • JVD • S3 • AFib -LR < 0.60: • Overall judgement of ED physician • No history of heart failure • No dyspnea on exertion • No rales • Lack of cardiomegaly / congestiong • BNP < 100 pg/ml Adapted from JAMA Evidence Based Physical Examination #chf #cardiology #heartfailure #physicalexam #diagnosis

Heart Failure (HFrEF) Treatment - GDMT for stage C For patients with Heart Failure with REDUCED Ejection Fraction (HFrEF), we follow Guideline-Directed Medical Therapy (GDMT). GDMT is basically getting patients on medication regimens that have been evidenced to have a mortality benefit, while also considering adding other agents for morbidity benefits when appropriate. In patients with HFrEF, we should initiate them on ACEI or ARB and an evidenced beta-blocker since these have mortality benefits. It's important to have both of these medications on board, then titrate them up to the target dose (as tolerated). If patients have edema then add on loop diuretics. After a patient is on maximally tolerated ACEI/ARB + Beta-Blocker, we can move to the next section of possible agents. Agents with mortality benefit in second-line include Entresto (replacing ACEI/ARB), spironolactone, and BiDil (for African American patients). Additionally we can consider adding ivabradine if patients HR is still >70 despite the beta blocker. This process is recommended by the ACC/AHA guidelines. We may also consider digoxin for morbidity benefits in certain situations as well. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #CHF #sCHF #HeartFailure #HFrEF #Pharmacology #Management #Treatment #StageC #Cardiology

Causes of Iron Deficiency - Differential Diagnosis Algorithm • Blood loss: GI (cancer, ulcer, IBD), GU (cancer), GYN (cancer, menses), Epistaxis, Surgery, Hemodialysis • Iron loss: Intravascular hemolysis, (PNH, sickle-cell, prosthatic valve), Intensive athletic training, Pulmonary hemosiderosis • Inadequate intake for needs: Infancy, Adolescence, Pregnancy, Lactation, Low iron diet MALABSORPTION • Decreased ferrous iron from achlorhydria: PPI or H2-blocker, H.pylori, Atrophic gastritis, Gastrectomy • Increased hepcidin: Chronic kidney disease, Heart failure, Cancer/Waldenstroms, Rheumatoid arthritis and other chronic inflammatory conditions, Obesity, Polycythemia vera • Competitive inhibition with DMT1: Zinc, Manganese, Calcium, Cadmium, Lead • Structural problem (loss of sites of absorption): Celiac disease, Bypass surgery, Bacterila overgrowth, Hookworm, whipworm - Dr. Tony Breu @tony_breu #Iron #Deficiency #Differential #Diagnosis #Causes #Fe #algorithm