IRON DEFICIENCY MANAGEMENT IN HYPERTENSIVE SUBJECTS WITH ACUTE HEART FAILURE: FROM CLINICAL TRIALS TO CLINICAL PRACTICE

Abstract

Objective: Iron deficiency (ID) is common in heart failure (HF) and independently increases the risk of re-hospitalisation for HF. Intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms and quality of life in patients with chronic HF and ID deficiency. We aimed to evaluate the effect of FCM on outcomes in hypertensive patients (HTs) who were stabilised after an episode of acute HF. Design and method: From november 2020 to july 2021, in 148 HTs consecutively admitted in our Hypertension Unit for acute HF with ejection fraction < 50%, a ID was found in 39 of them (51% men, mean age 71.1 ± 18.5 yrs). ID was defined as serum ferritin < 100ng/mL or serum ferritin 100–299ng/mL with transferrin saturasion < 20%. Before hospital discharge, HTs received FCM dose according to the extent of ID and then reapeated it at 4-week interval. The primary outcome was to assess first HF hospitalisation or cardiovascular (CV) death at 4 and at 12 weeks after discarged. The analysis of variance for repeated measures assesed the differences in the values of systolic blood pressure (SBP), diastolic blood pressure (DBP), N-terminal pro-B-type-natriuretic peptide (NT-pro-BNP, (in pg/mL) and haemoglobin (in g/L) from baseline to the follow-up (FU). Results: At 4 and 12-week SBP and DBP values were not different from baseline (123.2 ± 13.8 and 124.4 ± 13.2 vs. 124.1 ± 14.1, NS and 70.9 ± 9.8, 71.0 ± 10.0 vs. 71.8 ± 10.2 mmHg, NS, respecively). NT-pro-BNP values significantly decreased from baseline to the FU (8.100 ± 8.132 vs. 6.244 ± 4.280 and 4.126 ± 3.485, p < 0.05). Haemoglobin values significantly increased from baseline to the FW (9.5 ± 1.2 vs. 11.9 ± 1.3 and 12.2 ± 1.4, p < 0.005). At 4-week no patient was re-admitted for HF, while at the 12-week a re-hospitalisation was observed in 17,9% of cases. No CV death was observed during the FW. Conclusions: Administration of FDC is effective to prevent first HF re-hospitalization and as recommended in 2021 ESC HF-guidelines, iron supplementation with FDC should be considered for the reduction of HF re-hospitalizations also in HTs with LVEF < 50% recently hospitalized for worsening HF. However, our results must be confirmed in studies involving a greater number of subjects, and with a longer FW.