Intravenous iron for iron deficiency in heart failure with preserved ejection fraction. A multivariate analysis

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most prevalent HF phenotype. Iron deficiency (ID), a frequent comorbidity, is associated with a poor prognosis.

HFpEF patients included in the prospective acute HF registry of Geneva University Hospitals were included. Patients who received intravenous (IV) iron during the hospital stay were compared with those who did not using a COX proportional hazard model adjusting for baseline imbalances and prognostic factors. The primary endpoint was one-year risk of readmission for acute HF or all-cause death.

We included 467 patients (mean age 78 years, 49 % women). ID was present in 251 (54 %). IV iron was administered to 57 patients (22.7 %). Anaemia was present in 69 % of substituted versus 36 % of non-substituted patients (p < 0.01). One-year risk of death or HF-related rehospitalization was 46 % in substituted versus 43 % in non-substituted patients (p = 0.71). The hazard ratio of occurrence of the primary endpoint with IV iron administration was 1.08 (95 % CI 0.66-1.76) after adjustment for age, sex, body mass index, diabetes, chronic renal failure, chronic anaemia, NYHA class, NT-proBNP, plasma sodium, and estimated glomerular filtration rate.

ID was highly prevalent in hospitalized patients with acute HF, and most patients were not substituted. IV iron administration during the acute stay did not modify one-year risk of death or readmission for acute HF.