Efficacy of Intravenous Iron in Patients with Heart Failure with Reduced Ejection Fraction and Iron Deficiency: A Systematic Review and Meta-Analysis of Randomized Control Trials

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS American Journal of Cardiovascular Drugs Pub Date : 2024-03-22 DOI:10.1007/s40256-024-00635-7

Andrew Sephien, Denisse Camille Dayto, Tea Reljic, Xavier Prida, Joanna M. Joly, Matthew Tavares, Jason N. Katz, Ambuj Kumar

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Abstract

Background

The European Society of Cardiology (ESC) provided a focused update to the 2021 Guideline for the Management of Heart Failure, now providing a 1A recommendation for intravenous iron in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID). However, the findings from randomized controlled trials (RCT) are mixed. This systematic review of RCTs aims to provide an update and synthesize the evidence addressing the association of intravenous iron with patient-based outcomes in patients with HFrEF and ID.

Methods

Any RCT evaluating the effect of intravenous iron in patients with HFrEF and ID was eligible for inclusion. A complete search of the EMBASE and PubMed databases was conducted from inception until 15 September 2023. The primary outcome was the composite of the quality of life (QoL) questionnaires, while the secondary outcomes included first heart failure (HF) hospitalizations and all-cause mortality. Data extraction was performed independently by two reviewers. Data were pooled using a random-effects model.

Results

Of the 1035 references, 15 RCTs enrolling 6649 patients were included in this study. Intravenous iron was associated with significant improvement in the composite of QoL (standardized mean difference − 1.36, 95% confidence interval [CI] − 2.24 to − 0.48; p = 0.002), a significant reduction in first HF hospitalizations (hazard ratio [HR] 0.73, 95% CI 0.56–0.95; p = 0.02), and with no change in all-cause mortality (HR 0.90, 95% CI 0.79–1.03; p = 0.12). The certainty of the evidence ranged from moderate to very low.

Conclusion

Intravenous iron is possibly associated with improved QoL and reduced HF hospitalizations, without impacting all-cause mortality. These findings not only support the use of intravenous iron in patients with HFrEF but also emphasize the need for well-designed and executed RCTs with granular outcome reporting and powered sufficiently to address the impact of intravenous iron on mortality in patients with HFrEF and ID.

Registration

PROSPERO identifier number CRD42023389

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静脉注射铁剂对射血分数减低和缺铁性心力衰竭患者的疗效：随机对照试验的系统回顾和元分析》。

背景：欧洲心脏病学会（ESC）对《2021 年心力衰竭管理指南》进行了重点更新，目前提出了 1A 级建议，即建议射血分数降低型心力衰竭（HFrEF）和铁缺乏症（ID）患者静脉注射铁剂。然而，随机对照试验（RCT）的结果却不尽相同。本研究对随机对照试验进行了系统性回顾，旨在更新和综合有关静脉注射铁剂与射血分数减低性心力衰竭和缺铁性心力衰竭患者预后相关性的证据：任何评估静脉注射铁剂对 HFrEF 和 ID 患者影响的 RCT 均可纳入。从开始到 2023 年 9 月 15 日，对 EMBASE 和 PubMed 数据库进行了全面检索。主要结果是生活质量（QoL）问卷的综合结果，次要结果包括首次心衰（HF）住院和全因死亡率。数据提取由两名审稿人独立完成。采用随机效应模型对数据进行了汇总：在 1035 篇参考文献中，有 15 项 RCT 纳入了本研究，共纳入 6649 名患者。静脉注射铁剂可显著改善患者的综合生活质量（标准化平均差异-1.36，95% 置信区间[CI] - 2.24 至 - 0.48；P = 0.002），显著降低首次高血压住院率（危险比[HR] 0.73，95% CI 0.56-0.95；P = 0.02），全因死亡率无变化（HR 0.90，95% CI 0.79-1.03；P = 0.12）。证据的确定性从中度到极低不等：结论：静脉注射铁剂可能与改善QoL和减少HF住院有关，但不会影响全因死亡率。这些研究结果不仅支持在 HFrEF 患者中使用静脉注射铁剂，而且还强调了有必要进行精心设计和执行的 RCT，这些 RCT 应具有详细的结果报告和足够的动力，以研究静脉注射铁剂对 HFrEF 和 ID 患者死亡率的影响：PROSPERO标识符编号为CRD42023389。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.