Evidence-based approach to treating anemia and ID in patients with HF. The figure represents our recommended approach to evaluation and treatment of anemia and/or ID in patients with HF. Supporting evidence, where available, is discussed in detail in the text. Since trials of IV iron did not include patients with Hb >15 g/dL, LVEF >45%, or NHYA class I, we do not recommend administering IV iron to such patients. Data for IV iron in patients with NYHA class IV are limited. There are no currently available prospective data on the safety and efficacy of IV iron administration beyond the last time point in the CONFIRM-HF trial (36 weeks); therefore, we do not recommend routinely administering IV iron beyond 36 weeks. See Table 1 for information and discussion about various IV iron preparations. In 1 study, the prevalence of intestinal malignancies was similar in iron-deficient HF patients with or without anemia (9.3% vs 10.5%, respectively; P = .55). Prevalence was lower in HF patients without ID, with or without anemia (6% and 1.5%, respectively).⁴²  In a different population, gastrointestinal malignancies were found in 2.6% and 1.5% patients with and without anemia, respectively.²⁴  In our opinion, HF patients with ID (with or without anemia) should be evaluated for possible sources of bleeding; those who are anemic but not iron deficient should be evaluated on a case-by-case basis. Routine age-, sex-, and risk-based cancer screening remains appropriate for all patients.