Cleland, J. G.F. et al. (2024) Intravenous iron for heart failure, iron deficiency definitions, and clinical response: the IRONMAN trial. European Heart Journal, (doi: 10.1093/eurheartj/ehae086) (PMID:38446126) (Early Online Publication)
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Abstract
Background and Aims: What is the relationship between blood tests for iron deficiency, including anaemia, and the response to intravenous iron in patients with heart failure? Methods: In the IRONMAN trial, 1137 patients with heart failure, ejection fraction ≤ 45%, and either serum ferritin < 100 µg/L or transferrin saturation (TSAT) < 20% were randomized to intravenous ferric derisomaltose (FDI) or usual care. Relationships were investigated between baseline anaemia severity, ferritin and TSAT, to changes in haemoglobin from baseline to 4 months, Minnesota Living with Heart Failure (MLwHF) score and 6-minute walk distance achieved at 4 months, and clinical events, including heart failure hospitalization (recurrent) or cardiovascular death. Results: The rise in haemoglobin after administering FDI, adjusted for usual care, was greater for lower baseline TSAT (Pinteraction < .0001) and ferritin (Pinteraction = .028) and more severe anaemia (Pinteraction = .014). MLwHF scores at 4 months were somewhat lower (better) with FDI for more anaemic patients (overall Pinteraction = .14; physical Pinteraction = .085; emotional Pinteraction = .043) but were not related to baseline TSAT or ferritin. Blood tests did not predict difference in achieved walking distance for those randomized to FDI compared to control. The absence of anaemia or a TSAT ≥ 20% was associated with lower event rates and little evidence of benefit from FDI. More severe anaemia or TSAT < 20%, especially when ferritin was ≥100 µg/L, was associated with higher event rates and greater absolute reductions in events with FDI, albeit not statistically significant. Conclusions: This hypothesis-generating analysis suggests that anaemia or TSAT < 20% with ferritin > 100 µg/L might identify patients with heart failure who obtain greater benefit from intravenous iron. This interpretation requires confirmation.
| Item Type: | Articles |
|---|---|
| Additional Information: | The trial was funded by the British Heart Foundation (grant award CS/15/1/31175) and Pharmacosmos. J.G.F.C. and J.J.V.M. are supported by a British Heart Foundation Centre of Research Excellence Award (RE/18/6/34217). |
| Status: | Early Online Publication |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Squire, Dr Iain and Graham, Dr Fraser and Kalra, Professor Paul and Wetherall, Miss Kirsty and Robertson, Mrs Michele and Cleland, Professor John and Thomson, Miss Elizabeth and Ford, Professor Ian and Pellicori, Dr Pierpaolo and Petrie, Dr Colin and McMurray, Professor John |
| Authors: | Cleland, J. G.F., Kalra, P. A., Pellicori, P., Graham, F. J., Foley, P. W.X., Squire, I. B., Cowburn, P. J., Seed, A., Clark, A. L., Szwejkowski, B., Banerjee, P., Cooke, J., Francis, M., Clifford, P., Wong, A., Petrie, C., McMurray, J. J.V., Thomson, E. A., Wetherall, K., Robertson, M., Ford, I., and Kalra, P. R. |
| 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 Heart Journal |
| Publisher: | Oxford University Press |
| ISSN: | 0195-668X |
| ISSN (Online): | 1522-9645 |
| Published Online: | 06 March 2024 |
| Copyright Holders: | Copyright © The Author(s) 2024 |
| First Published: | First published in European Heart Journal 2024 |
| Publisher Policy: | Reproduced under a Creative Commons licence |
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