From Awareness to Implementation: Iron Deficiency Management in Heart Failure — A National Survey of Cardiologists in Turkiye

Iron deficiency (ID) is a common comorbidity in heart failure (HF). Current guidelines recommend systematic assessment of iron status using ferritin and transferrin saturation (TSAT) and intravenous iron therapy for eligible patients. This study evaluated awareness, diagnostic practices, treatment preferences, and perceived barriers related to ID management among cardiologists in Türkiye. A national cross-sectional survey was conducted among cardiology residents, specialists, and academic cardiologists. An 11-item questionnaire assessed guideline awareness, diagnostic testing patterns, treatment practices, and barriers to intravenous iron use in patients with HF and reduced or mildly reduced ejection fraction. A total of 267 cardiologists were included. Most participants were familiar with contemporary recommendations for ID management in HF (94.4%). Ferritin (91.0%) and hemoglobin (88.4%) were the most frequently requested tests, whereas TSAT was routinely assessed by 63.3%. The European Society of Cardiology definition of ID was correctly identified by 61.4% of respondents. Routine TSAT use was strongly associated with correct recognition of guideline-defined ID (75.7% vs. 36.7%, p<0.001). Although intravenous iron was preferred by 73.8% of participants, only 22.5% reported routine administration. The main barriers were infusion logistics (51.3%), workload (44.6%), and reimbursement/reporting procedures (34.8%). Despite high awareness of ID among cardiologists, important gaps remain in the implementation of guideline-recommended diagnostic and therapeutic strategies. Underuse of TSAT and low rates of routine intravenous iron administration indicate that the major challenge in contemporary ID management is implementation rather than recognition.