Heart failure & cardiomyopathies

Meta-Analysis and Metaregression of the Treatment Effect of Intravenous Iron in Iron-Deficient Heart Failure

JACC Heart FailPublished Systematic review and meta-analysis of randomised trials

Authors' conclusion

The totality of data suggests that treatment with intravenous iron reduces both CV death and HF-related events in a broad population with HF. A lower baseline TSAT might be important for the effect on HF-related events.

Study context

Population
Heart failure (HF) patients with iron deficiency; RCTs published January 1, 2000, to August 26, 2023
Participants
6,624 patients14 RCTs
Comparison
IV iron vs placebo
  • Intravenous ironn = 3,407
  • Placebon = 3,217reference
Outcome
Cardiovascular (CV) death; CV death and HF admission; first HF admission; total HF admissions
Methodological detailsfixed effect model, metaregression (mixed effect model)
  • Fixed effect model
  • Metaregression (mixed effect model)

Pooled result

As reported in the abstract

Intravenous iron vs PlaceboEstimate (95% CI)P value
CV death
OR 0.867(0.755–0.955)
P = 0.0427
CV death and HF admission
OR 0.838(0.751–0.936)
P = 0.0015
First HF admission
OR 0.855(0.744–0.983)
P = 0.0281
Total HF admissions
rate ratio 0.739(0.661–0.827)
P < 0.0001

Further pooled results

Metaregression by baseline transferrin saturation (TSAT)

Trials enrolling patients with lower TSAT showed a large effect size on HF-related events

Original publication

Meta-Analysis and Metaregression of the Treatment Effect of Intravenous Iron in Iron-Deficient Heart Failure. JACC Heart Fail. Published 1 December 2023. doi:10.1016/j.jchf.2023.11.006

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