Three randomized trials (CONFIRM-HF, FAIR-HF and EFFECT-HF), of intravenous (IV) ferric carboxymaltose, in the treatment of iron deficiency in CHF patients with reduced left ventricular ejection fraction (LVEF) demonstrated improvement of symptoms, functional capacity and QoL. These beneficial effects were independent of the presence of anemia. CONFIRM-HF and subsequent meta-analyses indicated that treatment of iron deficiency may reduce the rate of hospitalizations for worsening CHF.

Although, oral iron is available at lower cost than IV iron, its use does not translate into beneficial effects in CHF patients with iron deficiency. Therefore, current guidelines advise establishing evidence-based pharmacological and device therapy to improve symptoms and prognosis in patients with CHF. In addition, screening for iron deficiency is recommended.

According to the ESC guidelines for acute HF and CHF, IV ferric carboxymaltose should be considered for treating iron deficiency in ambulatory symptomatic patients with reduced LVEF in order to alleviate HF symptoms, and to improve exercise capacity and QoL and should be considered as a routine part of HF care.