Iron Sucrose in Patients with Left Ventricular Assist Devices and Iron Deficiency

Abstract

Intravenous iron repletion in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency has been shown to safely improve functional capacity and quality of life. Despite common use of intravenous (IV) iron repletion in patients with left ventricular assist devices (LVADs) and iron deficiency, there is insufficient evidence regarding outcomes in this patient population. In this study, we quantified safety and efficacy endpoints in patients with LVADs and iron deficiency who were treated as inpatients with IV iron sucrose. We performed a retrospective analysis of patients on LVAD support with iron deficiency who received inpatient IV iron sucrose. Patient data was collected from a single, large academic medical center between 3/2017 and 7/2019. The primary endpoint was change in hemoglobin from baseline to 12 weeks post-infusion. Secondary endpoints were a change in mean corpuscular volume (MCV), ferritin, transferrin saturation, or New York Heart Association (NYHA) class from baseline to 12 weeks post-infusion. Safety endpoints included anaphylaxis, arrhythmias, or infections post-infusion and during admission. Iron deficiency was pre-defined as ferritin <100 ug/L or ferritin 100-299 ug/L with iron saturation < 20%. Patients with previous IV iron administration were excluded. A total of 54 patients (median age 59, IQR 50-68, 80% male) on LVAD support with iron deficiency received inpatient iron sucrose infusions between 3/2017 and 7/2019. Mean difference in hemoglobin at 12 weeks post-infusion was +2.2 g/dL (9.3 to 11.5 g/dL; p <0.001). Excluding patients who received blood products prior to the hemoglobin result at 12 weeks (17%, N=9), the mean difference was similar: +2.4 g/dL (9.3 to 11.7 g/dL; p <0.001). Prior to iron infusion, 35% of patients had an NYHA I or II compared to 73% at 12 weeks post infusion (p <0.001). Following IV iron administration, no patients experienced anaphylaxis, 2% had arrhythmias, and 3% had infections. Use of IV iron therapy in patients with continuous-flow LVAD is well-tolerated and associated with longitudinal improvements in hemoglobin and functional capacity. This adds to limited data regarding IV iron use in patients supported by LVAD.