Dataset Information

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

ABSTRACT:

Aims

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

Methods and results

We identified randomized trials published between 1 January 2000 and 5 November 2022 investigating the effect of IV iron versus 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 HHF and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality. Ten trials were identified with 3373 participants, of whom 1759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD (rate ratio 0.75, 95% confidence interval [CI] 0.61-0.93; p < 0.01) and first HHF or CVD (odds ratio [OR] 0.72, 95% CI 0.53-0.99; p = 0.04). Effects on cardiovascular (OR 0.86, 95% CI 0.70-1.05; p = 0.14) and all-cause mortality (OR 0.93, 95% CI 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, 95% CI 0.49-0.92) may have benefited more than those with values ≥20% (OR 0.99, 95% CI 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.

SUBMITTER: Graham FJ

PROVIDER: S-EPMC10946839 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Graham Fraser J FJ Pellicori Pierpaolo P Kalra Paul R PR Ford Ian I Bruzzese Dario D Cleland John G F JGF

European journal of heart failure 20230308 4

<h4>Aims</h4>For patients with heart failure (HF) and iron deficiency (ID), randomized trials suggest that intravenous (IV) iron reduces hospitalizations for heart failure (HHF), but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomized trials investigating the effect of IV iron on clinical outcomes in patients with HF.<h4>Methods and results</h4>We identified randomized trials published between 1 January 2000 and 5 November 202 ...[more]

PMID: 36823953

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Project description:BackgroundThe actual effects of intravenous iron therapy on hospitalizations, mortality and safety in patients with heart failure and iron deficiency remained controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to elucidate the cardiovascular benefits and safety of intravenous iron therapy.MethodsWe searched PubMed, Embase, and Cochrane Library databases for relevant RCTs of intravenous iron therapy in patients with heart failure and iron deficiency published from inception through April 20, 2024. Our primary endpoints of interest were heart failure hospitalizations, all-cause mortality, cardiovascular hospitalizations, and cardiovascular death. Additional risk of treatment complications included infections, administration site conditions, poisoning and procedural complications. We employed the fragility index and the reverse fragility index to further assess the robustness of our meta-analysis results. Additionally, subgroup analyses were conducted to explore potential clinical benefits.ResultsEleven trials encompassing a collective cohort of 6511 participants met our predefined eligibility criteria and were included in our meta-analysis. Intravenous iron therapy yielded a 21% relative reduction in heart failure hospitalizations and cardiovascular death (P<0.01), a 24% relative reduction in heart failure hospitalization (P<0.01) and a 28% relative reduction in cardiovascular hospitalizations and cardiovascular death (P<0.01). The corresponding high fragility indexes showed these pooled results to be robust. Our analysis revealed no statistically significant differences in terms of all-cause mortality (P = 0.11). Subgroup analyses revealed more favorable effects of intravenous iron therapy in trials that had a treatment duration of ≥ 24 weeks. The administration of intravenous iron did not have an additional risk of treatment-related complications (P = 0.93).ConclusionsIntravenous iron therapy in patients with chronic heart failure and iron deficiency significantly reduced rehospitalization for heart failure and cardiovascular death but was not associated with all-cause mortality. Long-term administration of iron supplements holds significant promise as a routine therapeutic approach for heart failure patients with iron deficiency.

Dataset Information

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

Aims

Methods and results

Conclusion

Publications

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

Similar Datasets

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