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Intravenous Iron Therapy in Patients Admitted With Acute Heart Failure and Iron Deficiency: A Systematic Review and

Victor Lopez1, Melissa Chacón2, María Jesús Arias2

  • 1Hospital Medicine, Sinai Hospital of Baltimore, Baltimore, USA.

Cureus
|September 2, 2025
PubMed

Insights

Intravenous iron in acute heart failure (AHF) with iron deficiency (ID) significantly improves hemoglobin levels but does not reduce rehospitalization or mortality rates. Larger trials are needed to confirm clinical benefits.

Area of Science:

  • Cardiology
  • Hematology

Background:

  • Intravenous (IV) iron is recommended for chronic heart failure (HF).
  • Its utility in acute heart failure (AHF) with iron deficiency (ID) is less established and debated.
  • Existing studies on IV iron in AHF have yielded controversial results.

Purpose of the Study:

  • To systematically review and meta-analyze evidence on the clinical effectiveness of IV iron in patients hospitalized with AHF and ID.
  • To provide robust data to guide clinical decision-making regarding IV iron use in this population.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Searched PubMed, Embase, Scopus, and Cochrane databases up to July 1, 2024.
  • Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) for re-hospitalization, mortality, and hemoglobin changes.

Main Results:

  • Included three RCTs and six observational studies with 3,588 patients; 1,622 received IV iron.
  • IV iron significantly increased hemoglobin levels (MD = 0.80; 95% CI = 0.33-1.27; p = 0.0003).
  • No statistically significant reductions were observed in HF re-hospitalization (RR = 0.96; p = 0.74), all-cause re-hospitalization (RR = 1.03; p = 0.64), or all-cause mortality (RR = 1.00; p = 0.87).

Conclusions:

  • IV iron effectively improves hemoglobin levels in patients with AHF and ID.
  • Current evidence does not support a significant impact of IV iron on reducing re-hospitalization or mortality in AHF.
  • Larger, high-quality RCTs are required to definitively assess the clinical outcomes of IV iron in AHF.

Keywords:
acute heart failureintravenous ironiron deficiencymortalityrehospitalization

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