Does intravenous iron reduce cardiovascular death or heart failure hospitalizations in patients with heart failure and iron deficiency, and does the definition of iron deficiency influence this effect?
Intravenous iron reduces cardiovascular death or heart failure hospitalizations only in heart failure patients with TSAT < 20%, suggesting TSAT alone should be used to identify patients for therapy.
Abstract Background Intravenous iron improves symptoms in heart failure (HF) with iron deficiency (ID) but failed to consistently show a benefit in cardiovascular outcomes. The ID definition used may influence the response to intravenous iron. The aim of this meta-analysis is to assess the influence of ID definition on the intravenous iron effect in HF. Methods/Results We performed a random-effects meta-analysis of randomized controlled trials (RCT) on intravenous iron (vs. placebo or standard of care) in patients with HF and ID that provided data on transferrin saturation (TSAT) and ferritin subgroups on the composite outcome of cardiovascular death (CVD) or HF hospitalizations (HFH). The risk ratio (RR) and 95% confidence intervals (95% CI) were extracted on the TSAT ( 5500 patients, intravenous iron reduced the composite outcome of CVD or HFH in those with a transferrin saturation (TSAT) < 20%, while for TSAT ≥ 20%, treatment effect was neutral. Ferritin, however, had no impact on intravenous iron response. This analysis suggests that the benefit from intravenous iron may be limited to patients with TSAT < 20%, irrespective of ferritin levels. Utilizing a TSAT < 20% to identify patients with ID who may benefit from intravenous iron therapy should be considered.
Marques et al. (Mon,) studied this question.