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The following is a summary of “Influence of iron deficiency definition on the efficacy of intravenous iron in heart failure: a meta-analysis of randomized trials,” published in the October 2024 issue of Cardiology by Marques et al.   

Intravenous iron therapy improves symptoms in patients with heart failure (HF) and iron deficiency (ID), but the impact on cardiovascular outcomes remains inconsistent.   

Researchers conducted a retrospective study to assess the impact of ID definitions on intravenous iron efficacy in patients with HF.   

They performed a random-effects meta-analysis of RCTs comparing intravenous iron to placebo or standard care in patients with HF and ID, focusing on transferrin saturation (TSAT) and ferritin subgroups for composite outcomes of cardiovascular death (CVD) or HF hospitalizations (HFH).   

The results showed that in patients with TSAT less than 20%, intravenous iron reduced the composite outcome of CVD or HF hospitalizations (risk ratio 0.81, 95% CI 0.69–0.94), while the effect was neutral in those with transferrin saturation greater than or equal to 20% (risk ratio 0.98, 95% CI 0.79–1.21; interaction, P=0.05). Data from 4 major RCTs were collected, including more than 5,500 patients. Ferritin levels did not modify the effect of intravenous iron (ferritin ≥ 100 ng/mL risk ratio 0.84, 95% CI 0.65–1.09; ferritin < 100 ng/mL risk ratio 0.85, 95% CI 0.74–0.97; interaction, P=0.96).   

They concluded that intravenous iron therapy may benefit patients with TSAT less than 20%, regardless of ferritin levels, highlighting the need to use transferrin saturation less than 20% as the sole criterion for identifying candidates for intravenous iron therapy.   

Source: link.springer.com/article/10.1007/s00392-024-02557-5