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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Article info
Publication history
Published online: May 19, 2020
Accepted:
April 13,
2020
Received in revised form:
March 11,
2020
Received:
December 15,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
