Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

Abstract

Aims Iron deficiency worsens symptoms, quality of life, and exercise capacity in chronic heart failure (CHF) and might do so by promoting fluid retention. We assessed whether iron repletion improved congestion in CHF and appraised the prognostic utility of calculated plasma volume status (PVS), a novel index of congestion, in the FAIR‐HF data set. Methods and results In FAIR‐HF, 459 iron deficient CHF patients were randomized to intravenous ferric carboxymaltose (FCM) or saline and assessed at 4, 12, and 24 weeks. Using weight and haematocrit, we calculated PVS in 436 patients. At baseline, PVS and weight were −5.5 ± 7.7% and 76.9 ± 14.3 kg, with peripheral oedema evident in 35% of subjects. Higher PVS values correlated to other congestion surrogates such as lower serum albumin. At 4 weeks, FCM was associated with greater reductions in weight (0.02) and PVS (P < 0.0001), and a trend for improved peripheral oedema at 24 weeks (0.07). Irrespective of treatment allocation, patients with a decrease in PVS from baseline to week 24 had higher increments in 6 min walking distance (61.4 m vs. 43.5 m, 0.02) and were more likely to improve their NYHA class (33.3% vs. 15.5%, 0.001). A PVS > −4% at baseline predicted worse outcomes even after adjustment for treatment assignment (hazard ratio 1.88, 95% confidence interval 1.01–3.51, 0.046). Conclusions Intravenous iron therapy with FCM is associated with early reductions in PVS and weight, implying that decongestion might be one mechanism via which iron repletion aids CHF patients. Calculated PVS is of prognostic utility in this cohort.

Short‐term changes in left and right systolic function following ferric carboxymaltose: a substudy of the Myocardial‐IRON trial

“…For instance, FCM can improve decongestion in the short term, as it has been reported in a recent substudy from the FAIR-HF trial. 29 The early improvement in right ventricular performance in our study may partly help to explain this symptomatic benefit. The potential association of iron status and right HF should be confirmed and explored in upcoming studies.…”

Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome

“…We surmise that in elderly patients with a cardiovascular pathology the frequent occurrence of multifactorial and sometimes of undefined anemia and the need for a fast correction of anemia suggests the use of blood transfusions also in moderate anemia, as it would result in a rapid, and possibly beneficial, increase of hemoglobin. In our view, ID and CDA should be easily diagnosed and resolved with the administration of rapidly effective iron supplies [35][36][37]. Likewise, vitamin supplementation, namely vitamin B 12 , instead of blood transfusions should be given in patients with vitamin deficiency anemia.…”

Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction

“…Once the patient is acutely treated and stabilized, some degree of BV expansion persists at clinical discharge, particularly in HF patients with reduced ejection fraction (HFrEF) (Miller and Mullan ). In the short term, pharmacological interventions decreasing BV may improve the functional status of HFrEF patients (Okonko et al , #121). With chronic treatment, however, HFrEF patients may develop hypovolemia (Anand et al ; Feigenbaum et al ; Bonfils et al ).…”