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Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and
Gregory D Lewis1, Rajeev Malhotra1, Adrian F Hernandez2
1Massachusetts General Hospital, Boston.
Insights
High-dose oral iron did not improve exercise capacity in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. These findings do not support oral iron supplementation for HFrEF patients.
Area of Science:
- Cardiology
- Hematology
- Clinical Trials
Background:
- Iron deficiency affects approximately 50% of patients with heart failure with reduced left ventricular ejection fraction (HFrEF).
- Iron deficiency is linked to reduced functional capacity and increased mortality in HFrEF patients.
- The effectiveness of oral iron supplementation in HFrEF patients with iron deficiency was previously unknown.
Purpose of the Study:
- To evaluate if oral iron therapy improves peak exercise capacity in patients diagnosed with HFrEF and iron deficiency.
Main Methods:
- A Phase 2, double-blind, placebo-controlled randomized clinical trial.
- Involved 225 patients with HFrEF (<40% ejection fraction) and iron deficiency.
- Participants received either 150 mg oral iron polysaccharide or placebo twice daily for 16 weeks.
Main Results:
- No significant difference in the change of peak oxygen uptake (V̇o2) between the oral iron and placebo groups after 16 weeks.
- Secondary endpoints, including 6-minute walk distance, NT-proBNP levels, and KCCQ scores, also showed no significant improvements with oral iron.
- The study included 225 randomized participants, with 203 completing the 16-week trial.
Conclusions:
- High-dose oral iron supplementation did not enhance exercise capacity in patients with HFrEF and iron deficiency over a 16-week period.
- The study's findings do not support the routine use of oral iron for this patient population.
- Further research may be needed to explore alternative iron formulations or treatment durations.
Importance:
Iron deficiency is present in approximately 50% of patients with heart failure with reduced left ventricular ejection fraction (HFrEF) and is an independent predictor of reduced functional capacity and mortality. However, the efficacy of inexpensive readily available oral iron supplementation in heart failure is unknown.
Objective:
To test whether therapy with oral iron improves peak exercise capacity in patients with HFrEF and iron deficiency.
Design, Setting, And Participants:
Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with HFrEF (<40%) and iron deficiency, defined as a serum ferritin level of 15 to 100 ng/mL or a serum ferritin level of 101 to 299 ng/mL with transferrin saturation of less than 20%. Participants were enrolled between September 2014 and November 2015 at 23 US sites.
Interventions:
Oral iron polysaccharide (n = 111) or placebo (n = 114), 150 mg twice daily for 16 weeks.
Main Outcomes And Measures:
The primary end point was a change in peak oxygen uptake (V̇o2) from baseline to 16 weeks. Secondary end points were change in 6-minute walk distance, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and health status as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ, range 0-100, higher scores reflect better quality of life).
Results:
Among 225 randomized participants (median age, 63 years; 36% women) 203 completed the study. The median baseline peak V̇o2 was 1196 mL/min (interquartile range [IQR], 887-1448 mL/min) in the oral iron group and 1167 mL/min (IQR, 887-1449 mL/min) in the placebo group. The primary end point, change in peak V̇o2 at 16 weeks, did not significantly differ between the oral iron and placebo groups (+23 mL/min vs -2 mL/min; difference, 21 mL/min [95% CI, -34 to +76 mL/min]; P = .46). Similarly, at 16 weeks, there were no significant differences between treatment groups in changes in 6-minute walk distance (-13 m; 95% CI, -32 to 6 m), NT-proBNP levels (159; 95% CI, -280 to 599 pg/mL), or KCCQ score (1; 95% CI, -2.4 to 4.4), all P > .05.
Conclusions And Relevance:
Among participants with HFrEF with iron deficiency, high-dose oral iron did not improve exercise capacity over 16 weeks. These results do not support use of oral iron supplementation in patients with HFrEF.
Trial Registration:
clinicaltrials.gov Identifier: NCT02188784.
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