Efficacy and safety of intravenous iron therapy in heart failure patients with iron deficiency: a systematic review and meta-analysis of randomized controlled trials

Mohammad  Tanashat; Mohamed Abouzid; Yehya  Khlidj; Mohamed  Abuelazm; Alaa  Ramadan; Obieda  Altobaishat; Aya  Aboutaleb; Irfan  Ullah; Basel  Abdelazeem

doi:10.20883/medical.e1183

Authors

Mohammad Tanashat Faculty of Medicine, Yarmouk University, Irbid, Jordan https://orcid.org/0000-0002-8819-1803
Mohamed Abouzid Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznań, Poland https://orcid.org/0000-0002-8917-671X
Yehya Khlidj Faculty of Medicine, Algiers University, Algiers, Algeria https://orcid.org/0000-0002-3448-9946
Mohamed Abuelazm Faculty of Medicine, Tanta University, Tanta, Egypt https://orcid.org/0000-0003-2047-2235
Alaa Ramadan Faculty of Medicine, South Valley University, Qena, Egypt
Obieda Altobaishat Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan https://orcid.org/0000-0001-7213-0507
Aya Aboutaleb Faculty of Medicine, Zagazig University, Zagazig, Egypt https://orcid.org/0000-0001-6979-9867
Irfan Ullah Department of Internal Medicine, Kabir Medical College, Gandhara University & Khyber Teaching Hospital, Peshawar, Pakistan https://orcid.org/0000-0003-1100-101X
Basel Abdelazeem Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA

DOI:

https://doi.org/10.20883/medical.e1183

Keywords:

iron, heart failure, deficiency, review, meta-analysis

Abstract

Introduction. Heart failure is a diverse life-threatening condition with complex biology and demanding therapeutic goals. Even when anemic patients are excluded, up to 59% of heart failure patients have low ferritin levels, making them especially vulnerable to iron deficiency. We aim to explore the benefits and safety of intravenous iron therapy among patients with heart failure and iron deficiency.

Material and methods. We have searched the literature on PubMed (MEDLINE), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WoS), and EMBASE until 31^st August, 2023. We used RevMan V. 5.4 to pool dichotomous data using a risk ratio (RR) with a 95% confidence interval (CI). This review has been registered and published in PROSPERO (CRD42023471419)

Results. Fourteen randomized controlled trials with 6,626 patients were included. The intravenous iron group was favored over the control group in reducing hospital admissions for heart failure (first event) (RR= 0.83, 95% CI 0.71 to 0.97; p = 0.02) and (total events) (RR= 0.81, 95% CI 0.74 to 0.89; p < 0.0001). Also, the iron group had a 21% lower risk in terms of cardiovascular death and hospital admission for heart failure (number of events, rate per 100 patients in a year) (RR= 0.79, 95% CI 0.74 to 0.85; p < 0.00001). Concerning the adverse events, both ferric carboxymaltose and ferric derisomaltose showed a beneficial effect in reducing the cardiac disorder (RR= 0.81, 95% CI 0.76 to 0.87; p <0.0001), and (RR= 0.82, 95% CI 0.71 to 0.95; p = 0.009), respectively.

Conclusions. Intravenous iron infusion in patients with heart failure has a favorable safety profile. It reduces total hospitalizations for heart failure and cardiovascular mortality, with no effect on all-cause mortality, cardiovascular mortality alone, or first-time hospitalization for heart failure.

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