Intravenous ferric carboxymaltose in patients with heart failure and iron deficiency: a systematic review and

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Mushood Ahmed1, Eeshal Zulfiqar2, Tallal Mushtaq Hashmi1

  • 1Department of Cardiology, Rawalpindi Medical University, Rawalpindi, Pakistan.

ESC Heart Failure
|February 19, 2026
PubMed

Insights

Intravenous ferric carboxymaltose (FCM) significantly reduces cardiovascular events and hospitalizations in heart failure patients with iron deficiency. This treatment also improves patient functional capacity, offering a key benefit for this vulnerable population.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Iron deficiency (ID) is prevalent in heart failure (HF) patients, correlating with adverse outcomes.
  • ID in HF patients is linked to poorer functional status, increased hospital admissions, and higher mortality rates.

Purpose of the Study:

  • To evaluate the efficacy of intravenous ferric carboxymaltose (FCM) in improving outcomes for HF patients diagnosed with ID.

Main Methods:

  • A meta-analysis of randomized controlled trials (RCTs) comparing FCM with placebo or standard care in HF patients with ID.
  • Literature search conducted up to April 15, 2025, focusing on primary outcomes of recurrent heart failure hospitalizations (HHF) or cardiovascular (CV) death at 1-year and complete follow-up.
  • Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.

Main Results:

  • Eleven RCTs involving 6493 patients showed FCM significantly reduced the composite of recurrent HHF or CV death at 1-year (RR 0.73) and over maximum follow-up (RR 0.80).
  • FCM administration significantly decreased recurrent HHF (1-year RR 0.69; complete follow-up RR 0.75) and improved 6-minute walk test performance (MD 29.19 m).
  • A trend towards reduced all-cause and CV mortality was observed at 1-year, though attenuated at longer follow-up. Trial sequential analysis confirmed robust evidence for the primary outcome.

Conclusions:

  • Intravenous FCM is associated with a reduced risk of adverse cardiovascular events in HF patients with ID.
  • FCM treatment leads to significant improvements in functional capacity for these patients.
  • Further research is warranted to fully elucidate the long-term survival benefits of FCM in HF patients with ID.
Abstract

Keywords:
Ferric carboxymaltoseHeart failureIron deficiencyMeta-analysis

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