Use of intravenous iron in patients with iron deficiency and chronic heart failure: Real-world evidence |
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| Institution: | 1. Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L''Hospitalet de Llobregat, Barcelona, Spain;2. Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L''Hospitalet de Llobregat, Barcelona, Spain;3. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA;4. Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L''Hospitalet de Llobregat, Barcelona, Spain;5. School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain;6. Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;7. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;8. CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain;9. Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders, Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain;10. Heart Failure Program, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain;11. Department of Internal Medicine, Hospital Universitari de Bellvitge, L''Hospitalet de Llobregat, Barcelona, Spain;1. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia;2. The University of Melbourne, Parkville, Victoria, Australia;3. Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia;1. Department of Tropical and Infectious Diseases, Policlinico Umberto I, Rome, Italy;2. Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy;3. Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy;4. Clinic of Infectious Diseases, University of Sassari, Sassari, Italy;5. Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy;6. Liver Unit, Hospital ‘‘G. Garibaldi” Catania, Catania, Italy;7. Department of Medical Sciences, University of Turin, Turin, Italy;8. Unit of Infectious Diseases, S. Anna and S. Sebastian Hospital, Caserta, Italy;9. Biomedical Department of Internal Medicine and Specialties (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy |
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| Abstract: | Introduction and objectivesTreatment with intravenous iron in patients with heart failure (HF) and iron deficiency (ID) improves symptoms, however its impact on survival and safety is unknown. We aimed to evaluate the management of ID and anemia with intravenous iron in patients with HF and long-term safety of intravenous iron.MethodsWe evaluated anemia and ID in patients with chronic HF at 3 university hospitals. Anemia was defined using the World Health Organization definition and ID was defined as ferritin <100 ug/L or a Transferrin Saturation <20% if ferritin between 100 and 299 ug/L. We assessed treatment with intravenous iron during follow-up and its association with mortality and HF hospitalizations using multivariate cox regression analysis.ResultsWe included 2,114 patients, median age 72 years and 57% had reduced left ventricular ejection fraction. ID was present in 55% and ID and anemia in 29%. Treatment with intravenous iron was used in 24% of patients with ID and 34% of patients with ID and anemia. In patients with ID, after multivariate adjustment, treatment with intravenous iron was associated with lower all-cause mortality: HR = 0.38 (0.28–0.56), lower cardiovascular mortality: HR = 0.34 (0.20–0.57) and no differences in HF hospitalizations: HR = 1.15 (0.88–1.50). Similar outcomes were found for patients with anemia and ID.ConclusionsIn a real-world cohort of patients with HF, treatment with intravenous iron was used in one third of patients with ID and anemia and appears safe in mid-term follow-up. |
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