Treatment for Iron Deficiency in Acute Heart Failure Is Critical

The administration of ferric carboxymaltose in patients with decompensated acute HF and iron deficiency is an effective treatment.

Treatment of iron deficiency (ID) in HF has become one of the most widely researched topics in recent years, according to Raquel López-Vilella, MD.

“The administration of IV iron in ambulatory patients with HF with reduced ejection fraction (HFrEF) has been found to improve HF symptoms, QOL, and left ventricular ejection fraction (LVEF), with no significant side effects,” Dr. López-Vilella and colleagues wrote.

Although recent studies have shown that IV administration of ferric carboxymaltose (FCM) prior to hospital discharge improves symptoms and decreases readmissions in patients with ID admitted for acute HF (AHF), there is limited research in real-world clinical practice.

Overall Incidence of Iron Deficiency Was 91.2%

For a study published in Life (Basel), Dr. López-Vilella and colleagues sought to ascertain whether the administration of FCM in patients with AHF and ID improves mortality and morbidity. The researchers analyzed 890 consecutive patients admitted for AHF, who were divided into six groups based on HFrEF or HF with preserved ejection fraction (HFpEF), presence of ID, and administration of FCM. At 6 months, readmissions, ED visits, and all-cause mortality were evaluated.

They observed that the overall incidence of ID was common, at 91.2% (Figure). Prevalence was 89.8% and 93%, respectively, in the HFrEF and HFpEF subgroups, and both values were close to statistical significance (P=0.07). When patients with untreated versus treated ID were compared within the HFrEF group, no differences were found in isolated events. However, differences were observed in the combined event rate (P=0.049). An absolute risk reduction (ARR) of 10% and a relative risk reduction (RRR) of 18% were observed, based on risk calculation.

“The number of patients we needed to treat to prevent a combined event was 10.5 in HFrEF and 10.8 in HFpEF,” the study authors wrote. “FCM in AHF reduced the combined event rate of emergency visits, re-admission, and all-cause death at 6 months in HF with left ventricular ejection fraction [less than] 50% and showed a positive trend in HFpEF.”

First Analysis of Ferric Carboxymaltose in Decompensated Acute HF

Patients without ID in the HFrEF group were on average 5 years younger than those with ID. “[This] may explain the lower incidence of comorbidities such as diabetes mellitus and hypertension,” the study authors wrote. Additionally, in this patient group, slightly higher LVEF was identified. For patients with HFpEF, there were some differences between the clinical characteristics of the subgroups. On average, patients without ID were 6 years younger and had a lower prevalence of diabetes mellitus.

The researchers pointed out that this study is the first to evaluate the efficacy of FCM in a significant cohort of patients with decompensated AHF with reduced and preserved ejection fractions in a real-world setting. Another strength of the study, they wrote, “is that a subgroup comparison was made to verify whether treatment with FCM in patients with ID could normalize the risk [for] morbidity and mortality to values found in non-ID patients.”

For reducing ED visits, readmissions for HF, and all-cause mortality, the administration of FCM in patients with decompensated AHF and ID is an effective treatment, according to the study authors. “This real-world evidence should be implemented as soon as possible in all patients admitted for decompensated HF, regardless of LVEF,” they wrote.