Background Clinical trials have demonstrated the symptomatic benefit of intravenous (IV) iron in iron-deficient patients with Heart Failure reduced Ejection Fraction (HFrEF) independent of haemoglobin. However, paucity in data exists regarding the optimal strategy and symptomatic benefit of IV iron in heart failure (HF) outside of trial settings in heterogenous cohorts. We report our experience of IV iron in multimorbid patients with end-stage HF.

Methods All patients receiving IV iron at our hospice between March 2020-June 2022 for HF were retrospectively identified. All HF subtypes were included. Data encompassing demographics, echocardiographic and haematological findings, medication history, symptomatology (NHYA Class and IPOS), and treatment were analysed in SPSS v28.

Results 13 patients (female:male 1:1.6, mean age 84.0±8.3 years) underwent IV iron infusion for NYHA Class II-IV HF. 5/13 (38.5%) had HFrEF. All patients had at least two additional major comorbidities. The mean baseline haemoglobin was 110g/L (±18.5g/L) with a median baseline ferritin of 21.0ng/mL (range 7–66ng/mL). A significant rise in ferritin post-infusion was sustained to a median of 4.5 months (median post-infusion ferritin 104ng/mL (range 51–431ng/mL), p=0.012). Median pre-infusion IPOS scores were 3.0 for breathlessness and 3.0 for fatigue. Of the 8/13 patients who had received their infusion over six months ago, 4/8 (50%) had documented evidence of symptomatic benefit of whom 3/8 (37.5%) received a second infusion. There were no adverse events recorded.

Conclusion Although small, our experience highlights the symptomatic benefit and sustained effect of IV iron in a multimorbid palliative HF cohort, and the deliverability of this specific service in a real-world hospice setting.