IV Iron supplementation reduces risk of Hospitalization among HF patients with Iron Deficiency

A new analysis revealed that the addition of intravenous iron in heart failure patients with iron deficiency reduced the risk of heart failure hospitalization without any effect on all-cause mortality. The study was published in the Journal of Cardiology. 

Heart failure (HF) patients with iron deficiency receive inadequate diagnosis and care. Iron deficiency anemia is widely present in heart failure patients with an increased prevalence in ambulatory patients. It is an independent predictor of worse functional capacity and survival. Risk factors for iron deficiency include female sex, advanced heart failure, and higher levels of N-terminal pro–B-type natriuretic peptide and C-reactive protein are the risk factors for iron. Iron deficiency in heart failure differs from other conditions of chronic inflammation and is defined as ferritin <100 µg/L or ferritin of 100-299 µg/L with a transferrin saturation <20%. It is generally known that intravenous (IV) iron can enhance the quality of life indices. Emerging evidence also supported the role of IV Iron in preventing cardiovascular events in patients with HF. But there were inconsistent results on the effects of IV Iron in patients with Heart failure and anemia. Hence researchers conducted a Meta-analysis and trial sequential analysis of various randomized trials to understand the benefits of IV Iron in heart failure patients with anemia. 

A literature search of multiple randomized controlled trials in various electronic databases was carried out to compared IV iron to usual care among patients with HF and reported cardiovascular (CV) outcomes were included. Primary outcome was the composite of first heart failure hospitalization (HFH) or CV death. Secondary outcomes included HFH (first or recurrent), CV death, all-cause mortality, hospitalization for any cause, gastrointestinal (GI) side effects, or any infection. Trial sequential analysis was performed and cumulative meta-analyses was done to evaluate the effect of IV iron on the primary endpoint, and on HFH. 

Results: 

• There were nine trials that enrolled 3337 patients.
• IV iron addition to usual care significantly reduced the risk of first HFH by 25% and also the risk of CV death. 
• IV iron also reduced the risk of the composite of hospitalization for any cause or death.
• No significant difference were seen in the risk of CV death, all-cause mortality, adverse GI events, or any infection among patients receiving IV iron compared to usual care. 
• IV iron benefits were directionally consistent across trials and crossed both the statistical and trial sequential boundaries of benefit. 

Thus, adding IV iron to patients with HF and iron deficiency reduced the heart failure risk and also the risk of heart failure hospitalization risk.

Further reading: Bhatia K et al. Clinical outcomes of intravenous iron therapy in patients with heart failure and iron deficiency: Meta-analysis and trial sequential analysis of randomized clinical trials. https://doi.org/10.1016/j.jjcc.2023.06.012