Intravenous Versus Oral Iron Replacement in Patients with a Continuous-Flow Left Ventricular Assist Device

Bode, Lauren E.; Wesner, Sharon; Katz, Jason N.; Chien, Christopher; Hollis, Ian B.

doi:10.1097/mat.0000000000000904

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…Iron deficiency is common in LVAD recipients, but its effect on survival, hospitalisations and FC has not been clearly established. [ 75 – 77 ] A recent pilot study of 33 patients was unable to show the expected significant improvement in the 6MWT after intravenous iron replacement 6 months after implantation. [ 78 ] These findings have yet to be challenged in a randomised prospective study.…”

Section: Resultsmentioning

confidence: 99%

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Mirza

Gustafsson

2020

Card Fail Rev

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Continuous-flow left ventricular assist devices (LVAD) are increasingly used as destination therapy in patients with end-stage heart failure and, with recent improvements in pump design, adverse event rates are decreasing. Implanted patients experience improved survival, quality of life (QoL) and functional capacity (FC). However, improvement in FC and QoL after implantation is not unequivocal, and this has implications for patient selection and preimplantation discussions with patients and relatives. This article identifies preimplantation predictors of lack of improvement in FC and QoL after continuous-flow LVAD implantation and discusses potential mechanisms, allowing for the identification of potential factors that can be modified. In particular, the pathophysiology behind insufficient improvement in peak oxygen uptake is discussed. Data are included from 40 studies, resulting in analysis of >700 exercise tests. Mean peak oxygen uptake was 13.4 ml/kg/min (equivalent to 48% of predicted value; 259 days after implantation, range 31–1,017 days) and mean 6-minute walk test distance was 370 m (182 days after implantation, range 43–543 days). Finally, the interplay between improvement in FC and QoL is discussed.

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Section: Resultsmentioning

confidence: 99%

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Mirza

Gustafsson

2020

Card Fail Rev

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“…Researchers also found iron deficiency anemia in 62% (n = 67) of durable LVAD recipients. Thirty‐one of these patients received either oral (n = 21) or intravenous (n = 10) therapy for their iron deficiency, with resolution occurring in 40% of those treated with IV iron products compared to 0% in the oral iron cohort 69 …”

Section: Chronic Outpatient Managementmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure, yet still require concomitant medications in order to achieve the best possible clinical outcomes. Since the outset of routine placement of durable, continuous‐flow LVADs, much of the medication management of these patients to date has been based on International Society of Heart and Lung Transplantation (ISHLT) guidance, most recently published in 2013. Since 2013, numerous multidisciplinary pharmacotherapy publications have increased the LVAD community's understanding of best practices with respect to medications. We identified the major domains of LVAD medication management and conducted a comprehensive search of US National Library of Medicine MEDLINE® database using keywords chosen to identify medication‐related publications of significance dated 2013 or later. Trials pertaining to the HeartMate II™ and the HeartMate™ 3 LVADs (Abbott, Chicago, IL) and the HeartWare™ HVAD™ System (Medtronic, Minneapolis, MN) were chosen for inclusion. Highest priority for inclusion was given to prospective, randomized, controlled studies. Absent these, controlled trials (retrospective or prospective observational) were given next‐highest consideration, followed by retrospective uncontrolled studies, and finally case series. Reference lists of qualified publications were reviewed to find any other publications of interest that were not discovered on initial search. Case reports were generally excluded, except where the insight gained was deemed to be uniquely pertinent. This document serves to provide a comprehensive review of the current understanding of optimal medication management in patients with durable, continuous‐flow LVADs.

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“…Changes in MCV were not reported. There was also no significant difference in NYHA functional class [19]. The discrepancy may be due to lack of power of the prospective study given small sample size, as only ten patients were in the treatment group.…”

Section: Discussionmentioning

confidence: 81%

“…Separately, there is a small prospective, observational study which compared IV ferric gluconate or ferumoxytol and oral iron among patients supported by LVAD [19]. There was no difference in hemoglobin change (+2.2 vs. +1.8 g/dL; p = 0.386).…”

Section: Discussionmentioning

confidence: 99%

Safety and Effectiveness of Intravenous Iron Therapy in Patients Supported by Durable Left Ventricular Assist Devices

Peters

Hanff

Genuardi

et al. 2022

JCM

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Aims: While it is common practice to use intravenous (IV) iron in patients with left ventricular assist devices (LVADs) and iron deficiency, there is insufficient evidence regarding outcomes in this patient population. We evaluated the safety and effectiveness of IV iron therapy in patients supported by LVADs with iron deficiency. Methods: We performed a retrospective analysis of iron deficient patients on continuous LVAD support at a large academic center between 2008 and 2019. Patients were divided into two cohorts based on IV iron sucrose treatment. The primary endpoint was hemoglobin at 12 weeks. Secondary endpoints were mean corpuscular volume (MCV) and New York Heart Association (NYHA) class at 12 weeks. Safety endpoints included hospitalization, infection, pump thrombosis, arrhythmia, and gastrointestinal bleed. Models were weighted by the inverse probability of receiving IV iron using a propensity score, and endpoints were adjusted for their corresponding baseline values. Results: Among 213 patients, 70 patients received IV iron and 143 patients did not. Hemoglobin at 12 weeks was significantly greater among those treated (intergroup difference: 0.6 g/dL; 95% CI, 0.1 to 1.1; p = 0.01), while MCV was similar in both groups (intergroup difference: 0.7 μm3; 95% CI, −1.3 to 2.7; p = 0.50). NYHA class distribution at 12 weeks was significantly different (odds ratio for improvement: 2.84; 95% CI, 1.42 to 4.68; p = 0.003). The hazards of adverse events in each group were similar. Conclusions: In patients with LVADs and iron deficiency, treatment with IV iron sucrose was safe and associated with improvements in functional status and hemoglobin.

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Intravenous Versus Oral Iron Replacement in Patients with a Continuous-Flow Left Ventricular Assist Device

Cited by 9 publications

References 10 publications

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Pharmacotherapy for durable left ventricular assist devices

Safety and Effectiveness of Intravenous Iron Therapy in Patients Supported by Durable Left Ventricular Assist Devices

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