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Intravenous ferric carboxymaltose for iron deficiency in heart failure patients: A meta-analysis with trial

Laila Shalabi1, Ahmed Ibrahim2, Shrouk Ramadan3

  • 1Faculty of Medicine, Gharyan University, Gharyan, Libya.

European Journal of Pharmacology
|November 2, 2025
PubMed

Insights

Intravenous ferric carboxymaltose (FCM) significantly lowers heart failure hospitalizations and cardiovascular death in patients with iron deficiency. This treatment supports its use as a targeted therapy for improving heart failure outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Iron deficiency affects 33-50% of chronic heart failure patients, correlating with poorer prognoses.
  • Intravenous (IV) ferric carboxymaltose (FCM) is a potential therapeutic agent for this population.
  • Assessing FCM's impact on heart failure outcomes is crucial for clinical practice.

Purpose of the Study:

  • To evaluate the efficacy of IV ferric carboxymaltose (FCM) in patients with chronic heart failure and iron deficiency.
  • To determine the effect of FCM on key heart failure-related endpoints, including hospitalizations and mortality.

Main Methods:

  • A systematic literature review of randomized controlled trials (RCTs) was conducted across major databases (PubMed, Scopus, Cochrane Library, Web of Science) up to May 2025.
  • Pooled risk ratios (RRs) were calculated using a fixed-effect model for primary outcomes (heart failure hospitalization or cardiovascular death), total heart failure hospitalizations, and total all-cause hospitalizations.
  • Trial sequential analysis (TSA) was employed to validate the robustness and statistical power of the findings.

Main Results:

  • Nine RCTs involving 7491 patients demonstrated that FCM significantly reduced the risk of heart failure hospitalization or cardiovascular death (RR 0.89, P=0.0016).
  • FCM also significantly lowered heart failure hospitalizations (RR 0.82, P<0.0001) and cardiovascular death (RR 0.89, P=0.0384).
  • No significant difference was observed in total all-cause hospitalizations (RR 0.93, P=0.0830), though TSA confirmed conclusive evidence for the primary outcome.

Conclusions:

  • Ferric carboxymaltose (FCM) effectively reduces heart failure hospitalizations and cardiovascular death in patients with iron-deficient heart failure.
  • While FCM does not significantly impact all-cause hospitalization rates, its benefits on specific cardiovascular outcomes support its role as a targeted therapeutic strategy.
  • The findings underscore the importance of addressing iron deficiency in heart failure management.
Abstract

Keywords:
Ferric carboxymaltoseHeart failureIron deficiencyMeta-analysis

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