Treatment
Use of oral iron
There is limited clinical evidence from RCTs supporting the use of oral iron in patients with HF and iron deficiency2
In IRONOUT-HF – the only large RCT in patients with HFrEF and iron deficiency – oral iron polysaccharide did not improve exercise capacity2* and failed to achieve iron repletion in the majority of patients over 16 weeks in this trial3†
Therefore, the 2021 ESC guidelines for acute and chronic HF state: “Oral iron therapy is not effective in iron repletion and did not improve exercise capacity in patients with HFrEF and iron deficiency. It is therefore not recommended for the treatment of iron deficiency in patients with HF”4
References & footnotes
Footnotes
*In the IRONOUT-HF trial, 225 adults with HFrEF and iron deficiency (defined as a serum ferritin level of 15–100 ng/mL or 101–299 ng/mL with TSAT <20%) were randomised to oral iron polysaccharide or placebo for 16 weeks. The primary endpoint was a change in peak oxygen uptake (VO2) from baseline to 16 weeks.2
†In a post hoc analysis of the IRONOUT-HF trial to identify responders to oral iron polysaccharide in patients with HFrEF and iron deficiency, 76% of patients were still iron-deficient after 16 weeks of oral iron treatment.3
Abbreviations
ESC, European Society of Cardiology; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; ID, iron deficiency; IV, intravenous; RCT, randomised controlled trial; TSAT, transferrin saturation; VO2, Volume of oxygen uptake.
References
- Ferinject UAE SmPC. Ferinject KSA SmPC.
- Lewis GD et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: the IRONOUT HF randomised clinical trial. JAMA 2017;317(19):1958–66.
- Ambrosy AP et al. Identifying responders to oral iron supplementation in heart failure with a reduced ejection fraction: a post-hoc analysis of the IRONOUT-HF trial. J Cardiovasc Med 2019;20(4):223–5.
- McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599–726.
- McDonagh TA et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;44(37):3627–39.
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