Heart failure patients who had intravenous iron were less likely to be hospitalised or die during a UK study.
Intravenous iron reduces hospitalisations and cardiovascular death in people with heart failure, according to research published in The Lancet.
The randomised, open-label, blinded-endpoint trial found that patients who had intravenous iron infusions every four months had an 18% lower risk of cardiovascular death or hospital admission for heart failure.
“For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population,” the authors wrote.
People with heart failure were at risk of developing recurrent iron deficiency if their iron levels were not regularly “topped up”, lead author Dr Paul Kalra said in a statement.
“This study builds on existing evidence such that intravenous iron may benefit a broad range of people with heart failure, including those who are hospitalised, recently discharged or attending office or out-patient clinic appointments.”
The UK study randomised more than 1000 people with heart failure at 70 UK hospitals into two groups. One group had intravenous ferric derisomaltose, with the dosage calculated according to body weight, at one month and every four months afterwards. The other received usual heart failure care.
Patients were followed for an average of 2.5 years, and some for as long as 5.4 years.
Researchers found that 36% of people who had regular iron infusions had cardiac events, compared to 43% in the usual care group. People who had intravenous iron also reported better wellbeing after four months, and long-term intravenous iron was not associated with higher risk of infection or adverse cardiac events.
There were fewer serious adverse cardiovascular events in the iron infusion group and improvements at four months in overall and physical domain scores, the authors said.
However, while the intravenous iron group reported overall better quality of life and physical domain scores at four months, there was no difference between the groups at 20 months, in the EQ-5D quality of life scores at four or 20 months, or in the walk test at four months.
The authors noted that patient recruitment slowed during the covid pandemic and some patients were not willing or able to attend every appointment to check their iron levels or have IV iron infusions, and some might not have received enough ferric derisomaltose to maintain iron repletion.
Analysis taking into account missed appointments showed a 24% reduction in hospitalisations and cardiac deaths among patients who had intravenous iron compared to patients in the usual care group.
“In a post-hoc analysis in which patients were further censored at one-year of follow-up to enable closer comparison with the AFFIRM-AHF trial, the magnitude of the treatment effect appeared to be further enhanced,” the authors added.
The findings add further weight to the benefits of intravenous iron supplementation for people with heart failure, as outlined in the updated Australian consensus statement.
“These results demonstrate that repeated dosing with IV iron is a beneficial, safe and well-tolerated treatment option that may improve the well-being of adults with heart failure and iron deficiency within a few months,” Dr Kalra said.
