Key result
IV iron reduces the composite of HF hospitalizations and CV death by ~46% vs placebo.
Why the study?
Intravenous iron therapy improves symptoms and quality of life in HF and ID, but its benefits on hard cardiovascular endpoints required investigation.
Does intravenous iron therapy reduce hospitalizations and mortality in patients with heart failure and iron deficiency?
Meta-Analysis (n=6,511)
Does intravenous iron therapy reduce hospitalizations and mortality in patients with heart failure and iron deficiency?
Intravenous iron therapy, predominantly ferric carboxymaltose, significantly reduces heart failure hospitalizations and the composite of heart failure hospitalizations and cardiovascular death in patients with heart failure and iron deficiency.
Answers are grounded in this paper and cite their sources.
Supports IV iron consideration in iron-deficient HF to cut hospitalizations; confirms pooled efficacy across 6511 patients.
BACKGROUND Intravenous iron therapy represents a promising potential treatment option for patients with heart failure (HF) and iron deficiency (ID), as it has been shown to improve clinical symptoms and enhance quality of life. To investigate the benefits of intravenous iron therapy on hard cardiovascular endpoints in HF and ID patients, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We implemented a systematical search of the PubMed, Embase and Cochrane Library databases for relevant RCTs of intravenous iron therapy in patients with HF and ID published from inception through January 20, 2024. Our primary endpoints of interest were HF hospitalizations, all-cause mortality, HF hospitalizations and cardiovascular death, cardiovascular hospitalizations and cardiovascular death. Sensitivity analyses and subgroup analyses were further performed to investigate additional clinical benefits in specific populations. RESULTS Eleven trials encompassing a collective cohort of 6511 participants met our predefined eligibility criteria and were included in our meta-analysis. The predominant form of intravenous iron utilized in the trials included in our analysis was ferric carboxymaltose. Intravenous iron therapy yielded a 40% relative reduction in HF hospitalization (OR 0.60, 95% CI 0.51-0.70; P = 0.00001), a 46% relative reduction in HF hospitalizations and cardiovascular death (OR 0.54, 95% CI 0.46-0.63; P <0.00001) and a 53% relative reduction in cardiovascular hospitalizations and cardiovascular death (OR 0.47, 95% CI 0.37-0.59; P <0.00001). Our analysis revealed no statistically significant differences in terms of all-cause mortality (OR 0.85, 95% CI 0.72-1.01; P =0.06) while this result was fragile (reverse fragility index of 2 and reverse fragility quotient of 0.0004). Subgroup analyses revealed more favorable effects of intravenous iron therapy in trials that had a follow-up duration of ≥ 24 weeks and a sample size of over 200 cases. Intravenous iron therapy had negligible effects on infection (OR 0.86, 95% CI 0.66-1.11; P =0.25), general disorders and administration site conditions (OR 1.35, 95% CI 0.93-1.94; P =0.11), injury, poisoning and procedural complications (OR 0.96, 95% CI 0.66-1.40; P =0.85). CONCLUSION Intravenous iron therapy in patients with HF and ID shows a significant reduction of rehospitalization for HF and cardiovascular death. The ferric carboxymaltose holds significant promise as a potential therapeutic agent for HF patients with ID.
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Wang et al. (2024) conducted a meta-analysis in Heart failure and iron deficiency (n=6,511). Intravenous iron therapy vs. Placebo was evaluated on Heart failure hospitalizations (OR 0.60, 95% CI 0.51-0.70, p=0.00001). Intravenous iron therapy reduced heart failure hospitalizations by 40% (OR 0.60) and the composite of heart failure hospitalizations and cardiovascular death by 46% (OR 0.54) compared to placebo.
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