Intravenous Ferric Carboxymaltose in Ischemic vs Nonischemic Heart Failure and Iron Deficiency: Insights From...

Previous studies have suggested that patients with ischemic etiology of heart failure (HF) and iron deficiency may derive greater benefits from intravenous ferric carboxymaltose (FCM). We aim to assess the effects of FCM vs placebo in patients with ischemic vs nonischemic etiology of HF.

The FAIR-HF2 trial included 1105 patients with HF, with a left-ventricular ejection fraction ≤ 45% and concomitant iron deficiency. Patients were randomized 1:1 to either intravenous FCM or placebo. Ischemic etiology was defined as investigator-reported or prior coronary revascularization or myocardial infarction. The primary endpoints were time-to-first-event of cardiovascular death or hospitalization due to HF, total HF hospitalizations, and time-to-first event of cardiovascular death or HF hospitalization in patients with transferrin saturation < 20% at baseline. Of 1105 patients, 858 (78%) had ischemic etiologies of HF. They were more commonly older and male and had more comorbidities. For the first primary endpoint, FCM was associated with a hazard ratio (HR) of 0.85 (95%CI: 0.66-1.10; P = 0.23) for ischemic HF and 0.61 (95% CI: 0.39-0.98; P = 0.038) for nonischemic HF (P-interaction = 0.26). The HR for the second primary endpoint was 0.87 (95% CI: 0.63-1.21, P = 0.41) for ischemic HF and 0.57 (95% CI: 0.35-0.94; P = 0.028) for nonischemic HF (P-interaction = 0.17), while HR for the third primary endpoint was 0.84 (95% CI: 0.62-1.14; P = 0.27) for ischemic HF and 0.63 (95% CI: 0.37-1.07; P = 0.087) for nonischemic HF (P-interaction = 0.35).

The effect of intravenous iron supplementation is likely to be similar in patients with ischemic or nonischemic etiology of HF, just like other HF guideline-directed medical therapies.