Abstract
BackgroundThe effectiveness of oral and intravenous iron supplementation in reducing the risk of mortality and hospitalizations in HF patients with iron deficiency is not well-established.MethodsA thorough literature search was conducted across 2 electronic databases (Medline and Cochrane Central) from inception through March 2021. RCTs assessing the impact of iron supplementation on clinical outcomes in iron deficient HF patients were considered for inclusion. Primary end-points included all-cause mortality and HF hospitalization. Evaluations were reported as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CI) and analysis was performed using a random effects model. I2 index was used to assess heterogeneity.ResultsFrom the 2599 articles retrieved from initial search, 10 potentially relevant studies (n = 2187 patients) were included in the final analysis. Both oral (OR: 0.93; 95% CI: 0.08–11.30; p = 0.951) and intravenous (OR: 0.97; 95% CI: 0.73–1.29; p = 0.840) iron supplementation did not significantly reduce all-cause mortality. However, intravenous iron supplementation significantly decreased the rates of overall (OR: 0.52; 95% CI: 0.33–0.81; p = 0.004) and HF (OR: 0.42; 95% CI: 0.22–0.80; p = 0.009) hospitalizations. In addition, intravenous ferric carboxymaltose therapy significantly reduced the time to first HF hospitalization or cardiovascular mortality (RR = 0.70; 95% CI = 0.50–1.00; p = 0.048), but had no effect on time to first cardiovascular death (RR: 0.94; 95% CI: 0.70–1.25; p = 0.655).ConclusionOral or intravenous iron supplementation did not reduce mortality in iron deficient HF patients. However, intravenous iron supplementation was associated with a significant decrease in overall and HF hospitalizations.
Highlights
Iron deficiency is recognized as an important comorbidity and in dependent predictor of outcomes in patients with acute and chronic heart failure (HF) [1]
The updated Amer ican College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines and the European Society of Cardiology (ESC) guidelines recommend the use of intravenous iron supplementation in HF patients (NHYA Class II and III) with iron deficiency to alleviate their functional status and quality of life [9,10]
HF patients with reduced LVEF were recruited in all trials, with a cut-off for LVEF ranging from 35% to ≤50% at baseline
Summary
Iron deficiency is recognized as an important comorbidity and in dependent predictor of outcomes in patients with acute and chronic heart failure (HF) [1]. In light of the inconsistent results, we conducted a meta-analysis to evaluate the efficacy of iron supplementation in reducing mortality and hospitalizations in iron deficient HF patients. Results: From the 2599 articles retrieved from initial search, 10 potentially relevant studies (n = 2187 patients) were included in the final analysis. Both oral (OR: 0.93; 95% CI: 0.08–11.30; p = 0.951) and intravenous (OR: 0.97; 95% CI: 0.73–1.29; p = 0.840) iron supplementation did not significantly reduce all-cause mortality. Intravenous iron supplementation was associated with a significant decrease in overall and HF hospitalizations
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