Efficacy and safety of iron therapy in patients with chronic heart failure and iron deficiency: a systematic review and meta-analysis based on 15 randomised controlled trials.
Study Goal
The researchers aimed to evaluate the efficacy and safety of iron therapy in patients with chronic heart failure (CHF) and iron deficiency (ID), including its impact on exercise capacity (measured by 6MWT distance) and quality of life.
Results Summary
Iron therapy improved 6-minute walking test (6MWT) distance and quality of life in CHF patients with ID, but did not significantly reduce all-cause or cardiovascular death. It also reduced cardiovascular hospitalizations and improved cardiac function without increasing adverse events.
Population
Patients with chronic heart failure (CHF) and iron deficiency (ID), regardless of anemia status.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
iron therapy | decrease | cardiovascular hospitalisation | patients with CHF with ID | OR 0.35, 95% CI 0.12 to 0.99, p=0.049 | was demonstrated to reduce the risk of | #1 |
iron therapy | no change | all-cause death | patients with CHF with ID | OR 0.59, 95% CI 0.33 to 1.06, p=0.078 | was ineffective in reducing | #2 |
iron therapy | no change | cardiovascular death | patients with CHF with ID | OR 0.80, 95% CI 0.39 to 1.63, p=0.540 | was ineffective in reducing | #3 |
iron therapy | decrease | NYHA class | patients with CHF with ID | mean difference (MD) -0.73, 95% CI -0.99 to -0.47, p<0.001 | resulted in a reduction in | #4 |
iron therapy | increase | LVEF | patients with CHF with ID | MD +4.35, 95% CI 0.69 to 8.00, p=0.020 | an increase in | #5 |
iron therapy | increase | 6MWT distance | patients with CHF with ID | MD +35.44, 95% CI 11.55 to 59.33, p=0.004 | an increase in | #6 |
iron therapy | increase | QoL: EQ-5D score | patients with CHF with ID | MD +4.07, 95% CI 0.84 to 7.31, p=0.014 | an improvement in | #7 |
iron therapy | decrease | Minnesota Living With Heart Failure Questionnaire score | patients with CHF with ID | MD -19.47, 95% CI -23.36 to -15.59, p<0.001 | an improvement in | #8 |
iron therapy | increase | Patients Global Assessment (PGA) scale | patients with CHF with ID | MD 0.71, 95% CI 0.32 to 1.10, p<0.001 | an improvement in | #9 |
iron therapy | no change | adverse events | patients with CHF with ID | - | no significant difference in | #10 |
iron therapy | no change | serious adverse events | patients with CHF with ID | - | no significant difference in | #11 |
iron therapy | decrease | cardiovascular hospitalisation | patients with CHF with ID | - | reduces | #12 |
iron therapy | increase | cardiac function | patients with CHF with ID and anaemia | - | improves | #13 |
iron therapy | increase | exercise capacity | patients with CHF with ID and anaemia | - | improves | #14 |
iron therapy | increase | QoL | patients with CHF with ID and anaemia | - | improves | #15 |
iron therapy | no change | adverse events | patients with CHF with ID and anaemia | - | without an increase of | #16 |
Trials studying iron administration in patients with chronic heart failure (CHF) and iron deficiency (ID) have sprung up these years but the results remain inconsistent. The aim of this meta-analysis was to comprehensively evaluate the efficacy and safety of iron therapy in patients with CHF and ID. A literature search was conducted across PubMed, Embase, Cochrane Library, OVID and Web of Science up to 31 July 2019 to search for randomised controlled trials (RCT) comparing iron therapy with placebo in CHF with ID, regardless of presence of anaemia. Published studies reporting data of any of the following outcomes were included: all-cause death, cardiovascular hospitalisation, adverse events, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), N-terminal pro b-type natriuretic peptide, peak oxygen consumption, 6 min walking test (6MWT) distance and quality of life (QoL) parameters. 15 RCTs with a total of 1627 patients (911 in iron therapy and 716 in control) were included. Iron therapy was demonstrated to reduce the risk of cardiovascular hospitalisation (OR 0.35, 95% CI 0.12 to 0.99, p=0.049), but was ineffective in reducing all-cause death (OR 0.59, 95% CI 0.33 to 1.06, p=0.078) or cardiovascular death (OR 0.80, 95% CI 0.39 to 1.63, p=0.540). Iron therapy resulted in a reduction in NYHA class (mean difference (MD) -0.73, 95% CI -0.99 to -0.47, p<0.001), an increase in LVEF (MD +4.35, 95% CI 0.69 to 8.00, p=0.020), 6MWT distance (MD +35.44, 95% CI 11.55 to 59.33, p=0.004) and an improvement in QoL: EQ-5D score (MD +4.07, 95% CI 0.84 to 7.31, p=0.014); Minnesota Living With Heart Failure Questionnaire score (MD -19.47, 95% CI -23.36 to -15.59, p<0.001) and Patients Global Assessment (PGA) scale (MD 0.71, 95% CI 0.32 to 1.10, p<0.001). There was no significant difference in adverse events or serious adverse events between iron treatment group and control group. Iron therapy reduces cardiovascular hospitalisation in patients with CHF with ID, and additionally improves cardiac function, exercise capacity and QoL in patients with CHF with ID and anaemia, without an increase of adverse events.