Ferric carboxymaltose for patients with heart failure in all-range ejection fraction

Abstract

Introduction and objectives

Iron deficiency (ID) is common in heart failure (HF) patients and is linked to exercise impairment, worse quality of life, and HF hospitalisation. Clinical practice guidelines recommend checking and correcting ID with ferric carboxymaltose (FCM). However, there is a lack of evidence in patients with left ventricular ejection fraction (LVEF) >40%.

Methods

We included all HF outpatients treated with FCM after ID diagnosis (ferritin <100 ng/mL or ferritin 100–299 ng/mL and transferrin saturation <20%). We analysed clinical and analytical parameters before FCM administration and at 3 months according to LVEF: preserved (>50%), mildly reduced (41–49%), and reduced (<40%).

Results

We included 235 patients (51.5% female) aged 73.5 ± 10.7 years. Ninety-six patients have reduced LVEF (40.8%), 41 mildly reduced (17.4%), and 98 preserved (41.7%). Patients with preserved LVEF have more anaemia (42.6% vs 26.8% vs 52.6%; P = .02). Less than 50% of patients received the correct dose of FCM, especially patients with preserved LVEF (P = .004). One patient (0.4%) presented a local exanthema with no other adverse effects. At 3 months, all analytical parameters significantly improved, except haemoglobin (12.9 vs 13.0 mg/dL; P = .95) and natriuretic peptides (3261 vs 3471 pg/mL; P = .56) in mildly reduced LVEF patients. The functional class did not improve in preserved LVEF patients, but it did in the rest.

Conclusions

FCM is safe and effective in correcting ID in HF patients regardless of LVEF. Natriuretic peptides are reduced in all patients except those with mildly reduced LVEF. Functional class improvement is less likely in patients with preserved LVEF.