The following is a summary of “Intravenous iron for heart failure, iron deficiency definitions, and clinical response: the IRONMAN trial,” published in the April 2024 issue of Cardiology by Cleland et al.

Researchers conducted a prospective study to determine the correlation of blood tests for iron deficiency, anemia, and the response to intravenous iron in patients with heart failure (HF). 

They used the IRONMAN trial where 1,137 patients with HF were included, which either had ejection fraction ≤ 45% and/or serum ferritin <100 µg/L or transferrin saturation (TSAT) <20%. Patients were later randomized to receive either intravenous ferric derisomaltose (FDI) or usual care. The correlation between baseline anemia severity, ferritin, and TSAT to changes in hemoglobin from baseline to 4 months, Minnesota Living with Heart Failure (MLwHF) score, and 6-minute walk distance at 4 months were investigated along with evaluating clinical events such as HF hospitalization or cardiovascular death. 

The results showed that, after receiving FDI, hemoglobin rise was more pronounced in patients with lower baseline TSAT (P_interaction<0.0001), lower ferritin (P_interaction=0.028), and more severe anemia (P_interaction=0.14). Patients with greater anemia had better scores on the MLwHF questionnaire at four months (Overall P_interaction=0.14, Physical P_interaction=0.085, emotional P_interaction=0.043). No significant relationship was found between baseline TSAT or ferritin levels and MLwHF scores. Blood tests did not predict changes in walking distance with FDI compared to usual care. Patients without anemia or TSAT ≥ 20% had lower event rates with little benefit from FDI. Conversely, more severe anemia or TSAT < 20%, mainly with ferritin ≥ 100 µg/L, showed higher event rates and more considerable reductions in events with FDI, although not statistically significant.

Investigators concluded that patients with HF with anemia or SAT < 20% and ferritin > 100 µg/L might benefit more from intravenous iron. However, further research is needed to confirm this finding. 

Source: academic.oup.com/eurheartj/article/45/16/1410/7623201