Effects of 6-months of oral ferrous and ferric supplement therapy in patients who were hospitalized for decompensated chronic heart failure

Abstract

Objective Anemia is common in patients with chronic heart failure (CHF). This study aimed to examine the frequency of iron deficiency anemia in patients with CHF. We investigated the effects of oral ferrous or ferric supplementation on prognosis of CHF and quality of life. Methods A total of 201 patients with chronic decompensated heart failure were enrolled in a 6-month prospective study. Patients were randomly assigned to two groups. Patients in group I (n = 100) received ferrous fumarate and those in group II (n = 101) received ferric hydroxide polymaltose complex. Quality of life was measured by the 6-minute walking test (6MWT). Results A total of 49% of the patients had iron-dependent anemia in group I and 53.3% were anemic in group II. In group I, the number of anemic patients was significantly lower at 6 months after admission compared with at initial admission (49% versus 45%). Significant improvements were observed in hemoglobin values, the 6MWT distance, and New York Heart Association class after 6 months in both groups. Conclusions Iron deficiency is a significant comorbidity in CHF, even without anemia. Iron should be replaced orally or intravenously because it significantly improves the quality of life of patients.

Iron Deficiency in Heart Failure Patients and Benefits of Iron Replacement on Clinical Outcomes Including Comorbid Depression

“…In terms of IV iron, FAIR-HF (p,0.001) [29] CONFIRM-HF (p,0.001) [31] and Toblli (p,0.01) [32] established improvement, however, Yeo et al concluded a negligible increase [34]. For oral iron supplements, Zdravkovic demonstrated increases from baseline in both oral arms (p,0.001) [28]. In contrast, Karavidas et al [26] and IRONOUT-HF [27] found no benefit.…”

“…Iron Replacement for NYHA Classification and Health Related Quality of Life Measures Four (4) studies utilising oral iron replacement for HF patients with ID demonstrated mixed results in improving patient outcomes [25][26][27][28]. The KCCQ implemented in IRONOUT-HF and Karavidas et al drew conflicting conclusions of insignificant improvement in the IRONOUT-HF trial (p=0.57) [27], and significance by Karavidas et al (p=0.038) [26].…”

“…The KCCQ implemented in IRONOUT-HF and Karavidas et al drew conflicting conclusions of insignificant improvement in the IRONOUT-HF trial (p=0.57) [27], and significance by Karavidas et al (p=0.038) [26]. In terms of NYHA classification, of note is the direct contrast in findings between Zdravkovic et al illustrating benefit (p,0.0001) [28] and IRON-HF finding no improvement [25].…”

“…For oral iron both IRONOUT-HF [27] and the oral arm of IRON-HF [25] found an insignificant increase in VO2max. The 6MWT was implemented as a measure of aerobic capacity by seven studies [26,29,31,32,34], as depicted in Table 3, with four demonstrating benefit [28,29,31,32]. In terms of IV iron, FAIR-HF (p,0.001) [29] CONFIRM-HF (p,0.001) [31] and Toblli (p,0.01) [32] established improvement, however, Yeo et al concluded a negligible increase [34].…”

“…The four studies which utilised oral iron failed to draw definitive conclusions regarding the benefit of oral iron on NYHA classification or QoL measures. The study design of Zdravkovic et al, an unblinded and uncontrolled study compared changes to patient baseline to conclude significance [28]. This confounds the potential to ascertain benefit.…”