The Efficacy and Safety of Iron Supplementation in Patients With Heart Failure and Iron Deficiency: A Systematic Review and Meta-analysis

Cheng, Qi; Wei, Baozhu; Ding, Jinye; Wu, Huiting; Wang, Yanggan

doi:10.1016/j.cjca.2015.06.009

Cited by 53 publications

(41 citation statements)

References 41 publications

(40 reference statements)

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“…iron sucrose in two separate trials 19, 20. These include reduced risk of cardiovascular death or hospitalization for worsening HF, improved 6MWT distance, improved QoL, and improved NYHA class with no increased risk of adverse events as supported by two separate meta‐analyses of available evidence 21, 22. Of the trials included for these meta‐analyses, FAIR‐HF and CONFIRM‐HF accounted for the majority of patients owing to their sample sizes and were largely responsible for the findings.…”

Section: Discussionmentioning

confidence: 90%

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Yeo

Hadi³

et al. 2018

ESC Heart Failure

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AimsIron deficiency is highly prevalent in Southeast Asians with heart failure (HF) and associated with worse outcomes. This trial aimed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF.Methods and resultsFifty patients hospitalized for acute decompensated HF, regardless of ejection fraction, with iron deficiency (defined as serum ferritin <300 ng/mL if transferrin saturation is <20%) were randomized to receive either one dose of intravenous ferric carboxymaltose (FCM) 1000 mg or placebo (0.9% saline) following HF stabilization and before discharge in two Singapore tertiary centres. The primary endpoint was difference in 6‐min walk test (6MWT) distance over 12 weeks, while secondary endpoints were quality of life assessed using validated Kansas City Cardiomyopathy Questionnaire (KCCQ) and Visual Analogue Scale (VAS). Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups (from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m, respectively). Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo, but adjustment for baseline covariates and time attenuated this effect {adjusted mean difference between groups: 0.88 m [95% confidence interval (CI) −30.2 to 32.0, P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [adjusted mean difference: KCCQ −1.48 (95% CI −8.27 to 5.31, P = 0.670) and VAS 0.26 (95% CI −0.33 to 0.86, P = 0.386)]. FCM was well tolerated with no serious treatment‐related adverse events.ConclusionsIntravenous FCM administered pre‐discharge in Southeast Asians hospitalized with decompensated HF is clinically feasible. Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects.

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Section: Discussionmentioning

confidence: 90%

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Yeo

Hadi³

et al. 2018

ESC Heart Failure

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“…Intravenous iron therapy resulted in a reduction in NYHA class (a mean net effect) (À0Á54 class, 95% CI À0Á87 to À0Á21, P = 0Á001) and an increase in 6-minute walking test distance (+31 m, 95% CI 18-43, P < 0Á0001. It is notable that these results have been achieved without adverse events (Qian et al, 2016) The use of intravenous iron is now incorporated into European guidelines on the management of heart disease (McMurray et al, 2012) but intravenous iron for heart failure has not been studied in sub-Saharan Africa, where it seems more likely that other forms of iron replacement would have to be used for economic and operational reasons.…”

Section: Iron Supplementationmentioning

confidence: 99%

“…Intravenous iron therapy reduces the risk of the combined endpoint of death from all causes or hospital admission for heart disease [odds ratio (OR) 0Á44, 95% CI 0Á30-0Á64, P < 0Á0001], and the combined endpoint of death from heart disease or hospitalisation for worsening heart failure (OR 0Á39, 95% CI 0Á24-0Á63, P = 0Á0001) Qian et al, 2016). These highly medically and statistically significant results are accompanied by significant improvement in a range of morbidity scores and, perhaps not so surprisingly, haematological parameters.…”

Section: Iron Supplementationmentioning

confidence: 99%

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Makubi

Roberts

2017

Br J Haematol

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Summary Frank iron deficiency has been associated with a wide range of cardiac and pulmonary abnormalities including non‐ischaemic cardiomyopathy. Iron deficiency anaemia and isolated iron deficiency are well‐defined adverse prognostic factors in non‐ischaemic cardiac failure. Furthermore, iron‐deficient patients in chronic heart failure with a serum ferritin of <100 μg/l or <300 μg/l with reduced transferrin saturation of <20%, who were given intravenous iron showed improved clinical outcomes. Iron deficiency with or without anaemia affects over a quarter of the world's population, but the impact of iron deficiency in heart failure and the effective management of iron deficiency in heart failure in Lower and Middle Income Countries (LMICs) is not well described. Heart failure in African cohorts occurs at a younger age than in North America and Europe and is more likely to be due to hypertension. Recent studies suggest that iron deficiency anaemia, which is very common in heart failure patients in Africa, and iron deficiency are independently associated with a poor prognosis in heart failure. Preliminary data suggest that iron deficiency in patients with heart failure can be treated with oral iron, with significant beneficial effects on haematological and physiological variables. Cost may prohibit the use of intravenous iron on a large scale in LMICs and optimal regimes to treat iron deficiency in heart failure patients with oral iron therapy remain to be defined.

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“…Para finalizar, el metaanálisis de Qian y colaboradores 41 , que incluyó estudios publicados hasta diciembre de 2014, con un total de 907 pacientes, mostró que la suplementación de hierro redujo significativamente el riesgo de: a) hospitalización por IC, y b) el punto final combinado de hospitalización por IC y muerte, sin incrementar el riesgo de eventos adversos en pacientes con IC sistólica sintomática y deficiencia de hierro.…”

Section: Figuraunclassified

Clinical implications of iron deficiency/anemia in heart failure and approach to the treatment

Rodulfo¹,

Blanco²,

Amair³

et al. 2016

acnef

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Rev. Colomb. Nefrol. 2016; 3(1): 26 -40 Implicaciones clínicas de la deficiencia de hierro en la insuficiencia cardíaca y abordaje del tratamiento 26Implicaciones clínicas de la deficiencia de hierro en la insuficiencia cardíaca y abordaje del tratamiento José Ildefonzo Arocha Rodulfo 1 , Trina Navas Blanco 2 , Pablo Amair M. 3 , Rusvel Gómez Berroterán 4 ResumenEl déficit de hierro con o sin anemia está siendo reconocido cada vez más como una comorbilidad importante en los pacientes con insuficiencia cardíaca (IC). Aunque la deficiencia de hierro es fácilmente diagnosticada por medio de dos marcadores (ferritina sérica y saturación de transferrina), es subdiagnosticada en estos pacientes y pudiera afectar hasta el 50% de los mismos. Aun antes del inicio de la anemia, los pacientes con IC y déficit de hierro muestran disminución en el rendimiento físico y cognitivo, con una mala calidad de vida. Más aún, la deficiencia de hierro es un factor de riesgo, independiente de la anemia, de evolución desfavorable (muerte o trasplante cardíaco) en los pacientes con IC crónica. Varios estudios aleatorios controlados han mostrado mejoría en la capacidad de ejercicio, clase funcional de la New York Heart Association (NYHA) y calidad de vida, luego de la corrección del déficit de hierro. Diversos factores contribuyen al desarrollo de este déficit, incluyendo edad avanzada, falla renal, hemodilución, inflamación crónica y severidad de la IC. Una variedad de mecanismos se han postulado para explicar la asociación de déficit de hierro e IC, y su corrección, como un blanco terapéutico, está ganando una mayor atención.Palabras clave: Deficiencia de hierro, anemia, ferritina, insuficiencia cardíaca (fuente DeCS). Clinical implications of iron deficiency/anemia in heart failure and approach to the treatment AbstractIron deficit with or without anemia is being increasingly recognized as an important comorbidity in patients with heart failure. Although iron deficiency is easily diagnosed with two biomarkers (serum ferritin and transferrin saturation), it is underdiagnosed in these patients and could affects up to 50% of them. Even before the onset of anemia, heart failure patients with iron deficiency have decreased physical and cognitive performances and a poorer quality of life. Moreover, iron deficiency is a risk factor, independent of anemia, of

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The Efficacy and Safety of Iron Supplementation in Patients With Heart Failure and Iron Deficiency: A Systematic Review and Meta-analysis

Cited by 53 publications

References 41 publications

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Clinical implications of iron deficiency/anemia in heart failure and approach to the treatment

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