Intravenous Iron in Heart Failure Patients With Iron Deficiency: A Meta-Analysis of Randomized Controlled Trials.

Abstract

Background: The impact of intravenous iron therapy in heart failure (HF) patients with iron deficiency (ID) is still controversial.

Method: We performed an extensive search of electronic databases for pertinent studies, encompassing all records up to March 4, 2024. Using random-effects models in a meta-analysis, the collected outcomes data were then synthesized and analyzed.

Result: Fourteen trials with 7786 participants (iron therapy: n = 3994; control: n = 3792) were included. Intravenous iron therapy can decrease the risk of composite events of total hospitalization for HF and cardiovascular (CV) death (RR = 0.82 [0.72, 0.92]), total hospitalization for HF (RR = 0.78 [0.66, 0.91]), first hospitalization for HF and CV death (OR = 0.78 [0.65, 0.93]), CV death (OR = 0.86 [0.76, 0.98]), first hospitalization for HF(OR = 0.77 [0.61, 0.99]), but not significantly reduce the risk of all-cause mortality (OR = 0.93 [0.83, 1.04]). Furthermore, intravenous iron treatment can improve the distance of 6-min walking test (6MWT) (WMD = 18.99 [7.41, 30.57]). Subgroup analyses found that intravenous iron may be more beneficial in HF patients with transferrin saturation (TSAT) <20%, and those with ischemic heart disease. Meta-regression analysis revealed that baseline hemoglobin levels served as a significant moderator of the therapeutic efficacy of intravenous iron supplementation.

Conclusion: For HF patients with ID, intravenous iron therapy can decrease the risk of hospitalization for HF, CV death and improve their exercise capacity. Patients with ischemic cardiomyopathy or with TSAT <20% may derive greater benefit from intravenous iron therapy.