Find out more about the 2023 Focused Update of the 2021
European Society of Cardiology (ESC) Guidelines for the
management of patients with heart failure (HF) and iron deficiency
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Ferinject is indicated for the treatment of iron deficiency when: oral iron preparations are ineffective; oral iron preparations cannot be used; or there is a clinical need to deliver iron rapidly. The diagnosis of iron deficiency must be based on laboratory tests.1 |
Ferinject is indicated for the treatment of iron deficiency when: oral iron preparations are ineffective; oral iron preparations cannot be used; or there is a clinical need to deliver iron rapidly. The diagnosis of iron deficiency must be based on laboratory tests.1 |
2023 FOCUSED UPDATE OF ESC 2021 HF GUIDELINES
The 2021 ESC guidelines included recommendations for treatments for non-cardiovascular comorbidities, including iron deficiency.2
Iron deficiency, which can be present independently of anaemia, is common in patients with HF (present in up to 55% of patients with chronic HF and up to 80%
of patients with acute HF).2
Iron deficiency is associated with an increase in HF re-hospitalisation, reduced exercise capacity and high cardiovascular and all-cause mortality rates.2 In
patients hospitalised with acute HF, iron status (transferrin and ferritin) should be measured pre-discharge or early post-discharge to discern whether iron
depletion is present.2
In August 2023, the European Society of Cardiology published the 2023 focused update of the 2021 ESC guidelines, to address changes in recommendations
for the treatment of Heart Failure because of new evidence from several randomised controlled trials3
The table below includes the 2023 focused update of the 2021 ESC guidelines for the management of Heart Failure and iron deficiency.
European Society of Cardiology guidelines for the management of Heart Failure and iron deficiency:
2021 European Society of Cardiology guidelines:
Recommendation – Class I; Level of evidence: C1
It is recommended that all patients with HF be periodically screened for anaemia and iron deficiency with a full blood count, serum ferritin
concentration and TSAT.
2023 focused update of the 2021 ESC guidelines:
Recommendation – Class I; Level of evidence: A3
Intravenous iron supplementation is recommended in symptomatic patients with HFrEF and HFmrEF, and
iron deficiency, to alleviate HF symptoms and improve quality of life.
Recommendation – Class Ila; Level of evidence A3
Intravenous iron supplementation with ferric carboxymaltose or ferric derisomaltose should be considered in symptomatic patients with HFrEF and
HFmrEF, and iron deficiency, to reduce the risk of HF hospitalisation.
Ferinject has a well-characterised tolerability profile:1
- The most commonly reported adverse drug reaction (ADR) is nausea (3.2%), followed by injection/infusion site reactions, hypophosphataemia, headache, flushing, dizziness and hypertension. Injection/infusion site reactions comprise several ADRs which individually are either uncommon or rare
- The most serious ADR is anaphylactic reactions (rare); fatalities have been reported. Ferinject has a documented frequency of serious hypersensitivity reactions of less than 1 in 1,000. There have been reports of hypersensitivity reactions which progressed to Kounis syndrome (acute allergic coronary arteriospasm that can result in myocardial infarction)
- Ferinject should only be administered when staff trained to evaluate and manage anaphylactic reactions is immediately available, in an environment where full resuscitation facilities can be assured. The patient should be observed for adverse effects for at least 30 minutes following each Ferinject administration
- If hypersensitivity reactions or signs of intolerance occur during administration, the treatment must be stopped immediately. Facilities for cardio respiratory resuscitation and equipment for handling acute anaphylactic reactions should be available, including an injectable 1:1,000 adrenaline solution
- Hypophosphataemia is a common (≥1/100 to <1/10) adverse drug reaction. Symptomatic hypophosphataemia leading to osteomalacia and fractures requiring clinical intervention including surgery has been reported in the post marketing setting. Patients should be asked to seek medical advice if they experience worsening fatigue with myalgias or bone pain. Serum phosphate should be monitored in patients who receive multiple administrations at higher doses or long-term treatment, and those with existing risk factors for hypophosphataemia. In case of persisting hypophosphataemia, treatment with ferric carboxymaltose should be re-evaluated
Please refer to the Ferinject Summary of Product Characteristics for complete tolerability information
Find out moreADR, adverse drug reaction; ESC, European Society of Cardiology; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LVEF, left ventricular ejection fraction; QoL, quality of life; TSAT, transferrin saturation.
1. Ferinject Summary of Product Characteristics. 2. McDonagh T A, Metra M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599‑726 3. McDonagh TA, Metra M et al. 2023 Focused Update of the 2021 ESC Guidelines for diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;44(37)3627–3639.
Ferinject in patients with heart failure
Oral or IV iron
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