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Use of intravenous iron in patients with iron deficiency and chronic heart failure: Real-world evidence

  • José Gonzalez-Costello
    Affiliations
    Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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  • Miguel Cainzos-Achirica
    Affiliations
    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
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  • Josep Lupón
    Affiliations
    Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

    Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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  • Nuria Farré
    Affiliations
    Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders, Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain

    Heart Failure Program, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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  • Pedro Moliner-Borja
    Affiliations
    Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

    Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Cristina Enjuanes
    Affiliations
    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Marta de Antonio
    Affiliations
    Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

    CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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  • Lara Fuentes
    Affiliations
    Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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  • Carles Díez-López
    Affiliations
    Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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  • Antoni Bayés-Genis
    Affiliations
    Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

    Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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  • Nicolás Manito
    Affiliations
    Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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  • Ramón Pujol
    Affiliations
    Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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  • Josep Comin-Colet
    Correspondence
    Corresponding author.
    Affiliations
    Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

    Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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      Highlights

      • Iron deficiency and anemia are very prevalent in patients with heart failure.
      • Intravenous iron was used in 34% of patients with anemia and iron deficiency.
      • Heart failure patients treated with intravenous iron had a worse clinical profile.
      • Intravenous iron in heart failure patients appears safe in mid-term follow-up.

      Abstract

      Introduction and objectives

      Treatment 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.

      Methods

      We 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.

      Results

      We 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.

      Conclusions

      In 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.

      Keywords

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