The identification and management of comorbidities are central to the care of patients with atrial fibrillation (AF). The European Society of Cardiology (ESC) Guidelines for the management of AF specifically highlight the need to focus on coexistent hypertension, heart failure, diabetes mellitus, obesity and sleep apnoea.1 Could iron deficiency soon join the list and become a modifiable risk factor for patients with AF, irrespective of the presence of heart failure?
Extensive research over the last 2–3 decades has identified that for patients with heart failure and reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF), iron deficiency is common and is independently associated with impaired quality of life and higher risk of heart failure hospitalisation and cardiovascular death.2 Analysis of data from a number of trials of intravenous iron in patients with iron deficiency and HFrEF and HFmrEF has shown benefits on improvement in quality of life and reduction in risk of heart failure hospitalisation such that it has been included in recent guidelines.1 2 Yet even in this extensively evaluated area of medicine, there remain unanswered questions. For example, while iron deficiency is common and associated with adverse outcomes in patients with heart failure and preserved ejection fraction (HFpEF), there are limited data on the benefit or otherwise of intravenous iron in such patients;3 large outcomes trials are still awaited. …
