142 Intravenous iron for patients with iron deficiency and acute or chronic heart failure: a systematic review and meta-analysis

Abstract

<h3>Introduction</h3> The British Cardiovascular Society (BCS) previously published an article highlighting the evidence of use of iron therapy in patients with heart failure and iron deficiency. Iron deficiency, as defined by ferritin &lt;100 μg/L or between 100-300 μg/L with a transferrin saturation of &lt;20%, is very common in heart failure (HF), both with preserved and reduced ejection fraction. This review highlights the effect of use of intravenous iron therapy in patients with reduced ejection fraction (&lt;45%) as no previous meta-analysis is available in the literature, as far as we know. <h3>Methods</h3> Several databases were searched to identify RCTs that investigate the efficacy and safety of intravenous iron therapy in patients with acute or chronic heart failure. A meta-analysis was performed using RevMan with random effect model using inverse variance method. We used the odds ratio (OR) and mean difference (MD) for dichotomous and continuous outcomes, respectively presented with the corresponding 95% confidence interval (CI). <h3>Results</h3> A total of 11 studies were included with 3,436 patients with mean age of 68 years old. There was no statistically significant difference between intravenous iron therapy and placebo in terms of overall death, cardiovascular death, all-cause hospital admission, and gastrointestinal complications associated with HF. However, placebo was associated with statistically significant higher risk for HF-related hospitalization for any cardiovascular disorder with OR 1.59 [95% CI 1.09, 2.32, p=0.02], respectively. Additionally, there was statistically significant variation in serum ferritin and serum transferrin early after administration from baseline favoring intravenous iron with MD -189.62 [95%CI -236.55, -142.69, p=0.01], and -7.65 [95% CI -13.43, -1.87, p=0.009], respectively. Furthermore, intravenous iron therapy was associated with a significant improvement in HF patients’ functional status at 20 months, evaluated by both Kansas City Cardiomyopathy Questionnaire (KCCQ), and changes from baseline in 6 min walk test (6MWT) with MD -7.14 [95% CI -10.52, -3.76, p&lt;0.0001], and -38.86 [95% CI -49.72, -28.00, p&lt;0.00001], respectively. Finally, intravenous iron therapy was associated with a higher risk of complications and common side effects during administration, however, this was monitored during supplementation, and resuscitation facilities should be available at time of administration. <h3>Conclusion</h3> Our meta-analysis demonstrates the capability of intravenous iron therapy to improve clinically meaningful outcomes such as all-cause cardiovascular disease-related hospitalisation, but also improve important indices as well as functional status; however, intravenous iron showed no difference in term of mortality, which is still being evaluated in further RCTs. <h3>Conflict of Interest</h3> None to report