Journal of Cardiac Failure · Jul 29, 2026

Oral Iron for the Management of Iron-Deficient Anemia in Patients With Heart Failure Treated With Sodium-Glucose Co-Transporter 2 Inhibitors: A Prospective Study

By Marques P, Matias P, Alves M et al.

BACKGROUND: As a result of a chronic inflammatory state and upregulation of hepcidin, management of iron deficiency anemia in patients with heart failure often requires the use of intravenous iron. The background use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) enhances iron absorption and mobilization, potentially rendering HF patients responsive to oral iron formulations. METHODS: We conducted a single-arm, non-blinded, prospective "off-on-off" study. Baseline measurements were performed without oral iron ("off-treatment"), then participants received oral iron for 3-4 months ("on-treatment"), followed by discontinuation of oral iron and reassessment after 2-3 months ("off-treatment"). The primary outcome was overall change in hemoglobin across study sequences; secondary outcomes included changes in hematocrit, transferrin saturation (TSAT), and iron biomarkers. Our main hypothesis is that hemoglobin would increase with oral iron and subsequently decrease after oral iron discontinuation. RESULTS: A total of 42 and 36 patients completed the "on" and "off treatment" periods, respectively. 55% were women, mean age was 79±7 years, median ejection fraction was 40% (IQR 30-55), 62% were in NYHA class II, 71% had chronic kidney disease and all had anemia. After adjustment for relevant baseline characteristics, hemoglobin increased by +1.05 g/dL (95% CI +0.69 to +1.40) during the "on-treatment" period and decreased by -0.28 g/dL (95% CI -0.64 to +0.07) during the "off-treatment" period (joint P-value<0.01). Similar trajectories were seen for hematocrit, TSAT and total iron concentrations. CONCLUSION: In SGLT2i-treated HF patients, oral iron was associated with an increase in hemoglobin that decreased after treatment discontinuation. These findings support the use of oral iron to correct iron-deficiency in HF patients treated with SGLT2i.

doi.org/10.1016/j.cardfail.2026.07.018 PubMed 42526705 Interventions