Heart failure & cardiomyopathies
Intravenous ferric carboxymaltose in patients with heart failure and iron deficiency: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis
- systematic review and meta-analysis of randomized controlled trials with trial sequential analysis
- random-effects model
+1 more
- random-effects model
Authors' conclusion
Intravenous FCM in HF patients is associated with reduced risk of adverse cardiovascular events and improved functional capacity. Further trials are needed to clarify its long-term survival impact.
Study context
- Population
- Heart failure (HF) patients with iron deficiency (ID)Ferric carboxymaltose (FCM) 3,329 · control 3,164
- Participants
- 6,493 Eleven randomized controlled trials (RCTs)
- Comparison
- FCM with placebo or standard care
- FCMn = 3,329
- controln = 3,164reference
- Outcome
- composite of:
- Recurrent hospitalizations for heart failure (HHF)
- Cardiovascular (CV) death
- Follow-up
- 1-year and complete
Pooled result
As reported in the abstract
composite of:
- Recurrent hospitalizations for heart failure (HHF)
- Cardiovascular (CV) death
FCM vs controlRelative risk (95% CI)
1-year
0.73(0.62–0.85)
over maximum follow-up
0.80(0.68–0.94)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Recurrent HHF · 1-year and complete follow-up — FCM vs control | 0.69 (0.57–0.84) | |
| Recurrent HHF · 1-year and complete follow-up — FCM vs control · complete follow-up | 0.75 (0.60–0.94) | |
| All-cause and CV mortality · 1-year — All-cause mortality (time point not stated) — FCM vs control | 0.86 (0.74–1.00) | |
| All-cause and CV mortality · 1-year — FCM vs control · CV mortality at 1-year | 0.86 (0.72–1.02) | |
| 0.512Relative risk (log scale) |
| Outcome | MD (m) (95% CI) | |
|---|---|---|
| 6-minute walk test performance | 29.19 (11.95–46.43) | |
| −200204060Difference, m (linear scale) |
- All-cause and cardiovascular (CV) mortality: CV mortality at 1-year — FCM vs control: RR 0.86 (95% CI 0.72-1.02)
- All-cause and CV mortality: trend towards reduced; effect attenuated over longer follow-up
Baseline characteristics
- mean age
- 66.7 ± 10.6 years
- women
- 34.4%
- mean left ventricular ejection fraction
- 33.7 ± 8.8%
- mean haemoglobin
- 12.4 ± 1.8 g/dL
- mean transferrin saturation
- 18.9 ± 10.1%
Original publication
Intravenous ferric carboxymaltose in patients with heart failure and iron deficiency: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. ESC Heart Fail. Published 8 January 2026. doi:10.1093/eschf/xvaf018
Summarised from the published abstract; every number is checked against it