Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis

Link to article at PubMed

Eur J Heart Fail. 2023 Feb 23. doi: 10.1002/ejhf.2810. Online ahead of print.


BACKGROUND: For patients with heart failure (HF) and iron deficiency (ID), randomised trials suggest that intravenous (IV) iron reduces heart failure hospitalisations, but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomised trials investigating the effect of IV iron on clinical outcomes in patients with HF.

METHODS: We identified randomised trials published between January 1st 2000 and November 5th 2022 investigating the effect of IV iron vs standard care/placebo in patients with HF and ID in any clinical setting, regardless of HF phenotype. Trials of oral iron or not in English were not included. The main outcomes of interest were a composite of hospitalisations for heart failure (HHF) and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality.

RESULTS: Ten trials were identified with 3,373 participants, of whom 1,759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD [RR 0.75 (0.61-0.93), p<0.01] and first HHF or CVD [OR 0.72 (0.53-0.99), p=0.04]. Effects on cardiovascular [OR 0.86 (0.70-1.05), p=0.14] and all-cause mortality [OR 0.93 (0.78-1.12), p=0.47] were inconclusive. Results were similar in analyses confined to the first year of follow-up, which was less disrupted by the COVID-19 pandemic. Subgroup analyses found little evidence of heterogeneity for the effect on the primary endpoint, although patients with transferrin saturation <20% [OR 0.67 (0.49-0.92)] may have benefited more than those with values ≥20% [OR 0.99 (0.74-1.30)] (heterogeneity p = 0.07).

CONCLUSION: In patients with HF and ID, this meta-analysis suggests that IV iron reduces the risk of HHF but whether this is associated with a reduction in cardiovascular or all-cause mortality remains inconclusive. This article is protected by copyright. All rights reserved.

PMID:36823953 | DOI:10.1002/ejhf.2810

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