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

Graham, F. J., Pellicori, P. , Kalra, P. R., Ford, I. , Bruzzese, D. and Cleland, J. G.F. (2023) Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis. European Journal of Heart Failure, 25(4), pp. 528-537. (doi: 10.1002/ejhf.2810) (PMID:36823953)

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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.

Item Type:Articles
Additional Information:P.P. and J.G.F.C. are supported by the British Heart Foundation Centre of Research Excellence (RE/18/6134217). F.J.G., P.P. and J.G.F.C. have been awarded a project grant from the British Heart Foundation to assess the prevalence of iron deficiency in patients undergoing elective cardiac surgery (PG/2019/35089).
Glasgow Author(s) Enlighten ID:Graham, Dr Fraser and Cleland, Professor John and Ford, Professor Ian and Kalra, Professor Paul and Pellicori, Dr Pierpaolo
Authors: Graham, F. J., Pellicori, P., Kalra, P. R., Ford, I., Bruzzese, D., and Cleland, J. G.F.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:23 February 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in European Journal of Heart Failure 25(4): 528-537
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science