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Efficacy of Intravenous Iron in Patients with Heart Failure with Reduced Ejection Fraction and Iron Deficiency: A

Andrew Sephien1, Denisse Camille Dayto2, Tea Reljic3

  • 1Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, Birmingham, AL, USA. Sephien20@gmail.com.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|March 23, 2024
PubMed

Insights

Intravenous iron may improve quality of life and reduce heart failure hospitalizations in patients with heart failure with reduced ejection fraction and iron deficiency. Further research is needed to confirm effects on mortality.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • European Society of Cardiology guidelines recommend intravenous iron for heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID).
  • Evidence from randomized controlled trials (RCTs) is mixed, necessitating further synthesis.
  • This review addresses the association between intravenous iron and patient-based outcomes in HFrEF and ID.

Purpose of the Study:

  • To systematically review and synthesize evidence from RCTs on the efficacy of intravenous iron in patients with HFrEF and ID.
  • To evaluate the impact of intravenous iron on quality of life, heart failure hospitalizations, and all-cause mortality.

Main Methods:

  • Systematic review of RCTs evaluating intravenous iron in HFrEF and ID patients.
  • Searched EMBASE and PubMed databases up to September 15, 2023.
  • Pooled data using a random-effects model, focusing on quality of life, HF hospitalizations, and mortality.

Main Results:

  • Included 15 RCTs with 6649 patients; intravenous iron improved quality of life (SMD -1.36, p=0.002).
  • Significantly reduced first HF hospitalizations (HR 0.73, p=0.02) but showed no significant change in all-cause mortality (HR 0.90, p=0.12).
  • Certainty of evidence ranged from moderate to very low.

Conclusions:

  • Intravenous iron possibly improves quality of life and reduces HF hospitalizations in HFrEF patients with ID.
  • Findings support current guidelines but highlight the need for larger, well-designed RCTs to clarify mortality impact.
  • Emphasizes the need for granular outcome reporting in future trials.
Abstract

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