Key result
Lower-dose ferric carboxymaltose fails to correct iron deficiency or reduce mortality and rehospitalizations versus no supplementation.
Why the study?
While ferric carboxymaltose is recommended for iron deficiency in heart failure with reduced ejection fraction, the clinical significance of iron deficiency screening and treatment in real-life acute decompensated heart failure remained to be evaluated.
Does ferric carboxymaltose administration improve mortality, rehospitalizations, and iron deficiency correction in a real-world cohort of patients with acute decompensated heart failure?
Cohort (n=90)
Does ferric carboxymaltose administration improve mortality, rehospitalizations, and iron deficiency correction in a real-world cohort of patients with acute decompensated heart failure?
p-value: p=ns
In a real-world ADHF cohort, in-hospital ferric carboxymaltose was frequently underdosed and rarely continued post-discharge, resulting in no significant improvement in iron deficiency correction, mortality, or rehospitalizations.
Background: The correction of iron deficiency (ID) with ferric carboxymaltose (FCM) is a recommended intervention in heart failure (HF) with reduced ejection fraction. Our aim is to evaluate, in a real-life setting, the clinical significance of ID screening and FCM treatment in acute decompensated HF (ADHF). Methods: In a cohort of ADHF patients, the prevalence of ID and FCM administration were investigated. Among the 104 patients admitted for ADHF, in n = 90 (median age 84, 53.5% with preserved left ventricular ejection fraction—LVEF), a complete iron status evaluation was obtained. ID was detected in n = 73 (81.1%), 55 of whom were treated with in-hospital FCM. The target dose was reached in n = 13. Results: No significant differences were detected in terms of age, sex, comorbidities, or LVEF between the FCM-supplemented and -unsupplemented patients. During a median follow-up of 427 days (IQR 405–466) among the FCM-supplemented patients, only 14.5% received FCM after discharge; the mortality and rehospitalizations among FCM-supplemented and -unsupplemented patients were similar (p = ns). In a follow-up evaluation, ID was still present in 75.0% of the FCM-supplemented patients and in 69.2% of the unsupplemented patients (p = ns). Conclusions: In this real-life ADHF cohort, FCM was administered at lower-than-prescribed doses, thus having no impact on ID correction. The significance of our findings is that only achieving the target dose of FCM and pursuing outpatient treatment can correct ID and produce long-term clinical benefits.
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Capone et al. (2023) conducted a cohort in Acute decompensated heart failure and iron deficiency (n=90). Ferric carboxymaltose vs. No ferric carboxymaltose supplementation was evaluated on Mortality and rehospitalizations (p=ns). Ferric carboxymaltose at lower-than-prescribed doses failed to correct iron deficiency (75.0% vs 69.2%; p=ns) and resulted in similar mortality and rehospitalizations compared to no supplementation.
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