https://doi.org/10.55788/6b6671c0
“Iron deficiency occurs in 50–80% of the patients with HF,” said Prof. Piotr Ponikowski (Medical University Wroclaw, Poland) [1]. “Although the positive effect of intravenous FCM on exercise capacity and quality-of-life has been demonstrated, its effect on clinical outcomes is less clear.” Prof. Ponikowski and colleagues conducted a pooled analysis of patient-level data including randomised, double-blind, placebo-controlled trials that investigated the effect of FCM on prospectively recorded HF hospitalisations, CV death, and all-cause death for a minimum duration of 52 weeks, in patients with HF and iron deficiency.
The CONFIRM-HF (NCT01453608), AFFIRM-AHF (NCT02937454), and HEART-FID (NCT03037931; also presented at ESC 2023) trials met the inclusion criteria [2–4]. “The meta-analysis included approximately 4,500 patients, with a mean age of 70 years, and about 40% of the patients were women,” added Dr Ponikowski. The co-primary endpoints were a composite of total CV hospitalisations and CV death through 52 weeks, and a composite of total HF hospitalisations and CV death through 52 weeks.
The endpoint of total CV hospitalisations and CV death was met, favouring FCM over placebo (rate ratio [RR] 0.86; 95% CI 0.75–0.98; P=0.029; see Figure). The endpoint of total HF hospitalisations and CV death just missed statistical significance but showed a trend towards a benefit for patients who were randomised to FCM compared with those on placebo (RR 0.87; 95% CI 0.75–1.01; P=0.076). Prof. Ponikowski added that these effects were driven by a reduction in CV hospitalisations (RR 0.83; 95% CI 0.73–0.96; P=0.009) and HF hospitalisations (RR 0.84; 95% CI 0.71–0.98; P=0.025) but not by a reduction in time to CV death (RR 0.97; 95% CI 0.80–1.17; P=0.72) or all-cause death (RR 0.93; 95% CI 0.78–1.10; P=0.39).
Furthermore, the subgroup analysis revealed one significant interaction effect: patients with transferrin saturation levels <15% benefitted significantly more from treatment with FCM in terms of CV hospitalisations and CV death than patients with transferrin saturation levels ≥24% (Pinteraction=0.019). Finally, an exploratory analysis suggested that patients with a higher cumulative dose at 6 months may benefit more from treatment with FCM than those with lower cumulative doses.
Figure: Co-primary endpoint of total CV hospitalisations and CV death [1]
CI, confidence interval; CV, cardiovascular; FCM, ferric carboxymaltose; PBO, placebo.
“Based on the results of our meta-analysis, FCM should be considered as an option to reduce the risk for CV or HF hospitalisations in patients with HF with reduced or mildly reduced left ventricular ejection fraction and iron deficiency,” concluded Prof. Ponikowski. “Further research is needed to select the appropriate patients for this therapy and to assess the potential benefits of re-dosing in the first 6 months of treatment.”
- Ponikowski P, et al. Impact of ferric carboxymaltose (FCM) on heart failure-related clinical outcomes in patients with heart failure and iron deficiency: an individual participant data meta-analysis. Hot Line Session 2, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
- Ponikowski P, et al. Lancet. 2020;396(10266):1895–1904.
- Ponikowski P, et al. Eur Heart J. 2015;36(11):657–668.
- Mentz RJ, et al. The HEART-FID trial: efficacy and safety of ferric carboxymaltose as treatment for heart failure with iron deficiency. Hot Line Session 2, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
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Table of Contents: ESC 2023
Featured articles
How to manage arterial thrombosis and thromboembolism in COVID-19?
2023 ESC Guidelines & Updates
Heart failure: the 2023 update
Guidelines for Acute Coronary Syndrome
Guidelines for the management of cardiomyopathies
Cardiovascular disease and diabetes: new guidelines
Guidelines for the management of endocarditis
Trial Updates in Heart Failure
Traditional Chinese medicine successful in HFrEF
CRT upgrade benefits patients with HFrEF and an ICD
Catheter ablation saves lives in end-stage HF with AF
Meta-analysis: Does FCM improve clinical outcomes in HF?
HEART-FID: Is intravenous ferric carboxymaltose helpful in HFrEF with iron deficiency?
Natriuresis-guided diuretic therapy to facilitate decongestion in acute HF
DICTATE-AHF: Early dapagliflozin to manage acute HF
STEP-HFpEF: Semaglutide safe and efficacious in HFpEF plus obesity
Key Research on Prevention
Does colchicine prevent perioperative AF and MINS?
Diagnostic tool doubles cardiovascular diagnoses in patients with COPD or diabetes
Inorganic nitrate strongly reduces CIN in high-risk patients undergoing angiography
Finetuning Antiplatelet and Anticoagulation Therapy
Should we use anticoagulation in AHRE to prevent stroke?
Results of FRAIL-AF trial suggest increased bleeding risk with DOACs
The optimal duration of anticoagulation therapy in cancer patients with DVT
DAPT or clopidogrel monotherapy after stenting in high-risk East-Asian patients?
Assets for ACS and PCI Optimisation
Immediate or staged revascularisation in STEMI plus multivessel disease?
Lp(a) and cardiovascular events: which test is the best?
No benefit of extracorporeal life support in MI plus cardiogenic shock
Functional revascularisation outperforms culprit-only strategy in older MI patients
Can aspirin be omitted after PCI in patients with high bleeding risk?
Angiography vs OCT vs IVUS guidance for PCI: a network meta-analysis
OCTOBER trial: OCT-guided PCI improves clinical outcomes in bifurcation lesions
Other
Minimising atrial pacing does not reduce the risk for AF in sinus node disease
ARAMIS: Can anakinra alleviate acute myocarditis?
Expedited transfer to a specialised centre does not improve cardiac arrest outcomes
Acoramidis improves survival and functional status in ATTR-CM
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