Intravenous Iron Decreases Rehospitalizations but Does not Change mortality in Patients Admitted with Acute Heart Failure and Iron Deficiency: A Systematic review and Meta-analysis

Introduction: The role of intravenous (IV) iron in chronic heart failure has been well studied, however, its role in acute heart failure (AHF) is less well-known. Including the recent AFFIRM-HF trial, we performed a systematic review and meta-analysis to highlight the role of IV iron in AHF with iron deficiency. Hypothesis: We hypothesized that IV iron does not change mortality or heart failure re-hospitalization rates in patients with AHF with iron deficiency. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies published from inception till June 30, 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), and Cochrane database including only RCTs and Cohort studies. We also included one prospective and one retrospective Cohort studies and two RCTs in our meta-analysis. Eligible studies included adults with AHF, left ventricular ejection fraction less than 40%-50%, and able to receive IV iron therapy. Outcomes included re-hospitalization rates and overall mortality from 30 days to 52 weeks post randomization (in one RCT). We used random-effects model calculating Risk Ratio (RR) with 95% confidence interval (95% CI) using Review Manger 5.4 software. I2statistics was used to assess heterogeneity. Results: There were total 1561 participants in both groups (IV iron and placebo/control) of four studies. The controls were comparable in both cohort studies and both the RCTs were well matched. Our results showed re-hospitalization in 278 of 833 (33.37%) patients in the IV iron/exposure group and 337 of 728 (0.46%) patients in the placebo/control group. The pooled result showed that the risk of re-hospitalization was comparable across both groups (RR 0.85, 95%CI 0.62-1.17; I2=45%, P=0.14). However, subgroup analysis, including RCTs only showed that IV iron decreases re-hospitalization rate by 28% compared to placebo (RR 0.72, 95% CI: 0.64, 0.82, I2=0%, P<0.00001) but did not improve mortality when compared to placebo (RR 0.97, 95% CI: 0.73, 1.30, I2 =0%). Conclusions: IV iron showed significant improvement in re-hospitalization rate for AHF hospitalizations in iron deficient patients but did not improve overall mortality. We need larger RCTs to further validate its effect on mortality.

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Intravenous iron for heart failure with evidence of iron deficiency: a meta-analysis of randomised trials

Clinical Research in Cardiology ◽

10.1007/s00392-021-01837-8 ◽

2021 ◽

Author(s):

Fraser J. Graham ◽

Pierpaolo Pellicori ◽

Ian Ford ◽

Mark C. Petrie ◽

Paul R. Kalra ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Meta Analysis ◽

Intravenous Iron ◽

Fixed Effect Model ◽

Placebo Control ◽

Randomised Trials ◽

Patients With Heart Failure ◽

Heart Failure Hospitalisation ◽

Iv Iron

Abstract Background The recent AFFIRM-AHF trial assessing the effect of intravenous (IV) iron on outcomes in patients hospitalised with worsening heart failure who had iron deficiency (ID) narrowly missed its primary efficacy endpoint of recurrent hospitalisations for heart failure (HHF) or cardiovascular (CV) death. We conducted a meta-analysis to determine whether these results were consistent with previous trials. Methods We searched for randomised trials of patients with heart failure investigating the effect of IV iron vs placebo/control groups that reported HHF and CV mortality from 1st January 2000 to 5th December 2020. Seven trials were identified and included in this analysis. A fixed effect model was applied to assess the effects of IV iron on the composite of first HHF or CV mortality and individual components of these. Results Altogether, 2,166 patients were included (n = 1168 assigned to IV iron; n = 998 assigned to control). IV iron reduced the composite of HHF or CV mortality substantially [OR 0.73; (95% confidence interval 0.59–0.90); p = 0.003]. Outcomes were consistent for the pooled trials prior to AFFIRM-AHF. Whereas first HHF were reduced substantially [OR 0.67; (0.54–0.85); p = 0.0007], the effect on CV mortality was uncertain but appeared smaller [OR 0.89; (0.66–1.21); p = 0.47]. Conclusion Administration of IV iron to patients with heart failure and ID reduces the risk of the composite outcome of first heart failure hospitalisation or cardiovascular mortality, but this outcome may be driven predominantly by an effect on HHF. At least three more substantial trials of intravenous iron are underway. Graphic abstract

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Prognostic role of anemia in heart failure with preserved ejection fraction: A systematic review and meta-analysis

Indian Heart Journal ◽

10.1016/j.ihj.2021.06.011 ◽

2021 ◽

Author(s):

Monil Majmundar ◽

Rajkumar Doshi ◽

Harshvardhan Zala ◽

Palak Shah ◽

Devina Adalja ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Ejection Fraction ◽

Meta Analysis ◽

Preserved Ejection Fraction ◽

Prognostic Role

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Effect of Exposure to Cats and Dogs on the Risk of Asthma and Allergic Rhinitis: A Systematic Review and Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420932487 ◽

2020 ◽

Vol 34 (5) ◽

pp. 703-714

Author(s):

Xiaoping Gao ◽

Mei Yin ◽

Pei Yang ◽

Xia Li ◽

Lingling Di ◽

...

Keyword(s):

Systematic Review ◽

Allergic Rhinitis ◽

Cohort Studies ◽

Meta Analysis ◽

Pooled Analysis ◽

Protective Role ◽

Case Control ◽

Favorable Effect ◽

Case Control Studies

Background Controversies persist regarding whether exposure to cat or dog increases the risk of asthma and allergic rhinitis. Objective This meta-analysis aimed to assess the associations between exposure to cats or dogs and the development of asthma and allergic rhinitis. Methods A systematic review was performed to identify case-control and cohort studies before May 2019, evaluating the association between exposure to cats and dogs and the risk of asthma and rhinitis. The risk of bias was assessed using the Newcastle–Ottawa Scale. The odds ratios (ORs) and risk ratios (RRs) were pooled for case-control and cohort studies, respectively. Subgroup analyses were performed on prespecified study-level characteristics. Results The meta-analysis of 34 cohort studies showed a protective role of exposure to cats [RR: 0.88, 95% confidence interval (CI): 0.77–0.99] or dogs (RR: 0.85, 95% CI: 0.73–0.97) in the development of asthma. The subgroup analysis of birth cohort (RR: 0.74, 95% CI: 0.56–0.93) and children population (RR: 0.83, 95% CI: 0.70–0.96) also suggested a favorable role of exposure to dogs in the development of asthma. Pooled evidence from 13 case-control studies indicated no significant impact of cats (OR: 1.66, 95% CI: 0.39–2.94) and dogs (OR: 1.22, 95% CI: 0.92–1.52) on the development of asthma. A pooled analysis of five cohort studies showed a favorable effect of exposure to cats (RR: 0.60, 95% CI: 0.33–0.86) or dogs (RR: 0.68, 95% CI 0.44–0.90) on the development of allergic rhinitis. Conclusion The findings indicated a protective effect of exposure to cats and dogs, especially ownership, on the development of asthma and allergic rhinitis.

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The Association of Potentially Inappropriate Medication at Older Age With Cardiovascular Events and Overall Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2016.11.025 ◽

2017 ◽

Vol 18 (3) ◽

pp. 211-220 ◽

Cited By ~ 42

Author(s):

Dana Clarissa Muhlack ◽

Liesa Katharina Hoppe ◽

Janick Weberpals ◽

Hermann Brenner ◽

Ben Schöttker

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Cardiovascular Events ◽

Meta Analysis ◽

Inappropriate Medication ◽

Older Age ◽

Potentially Inappropriate Medication ◽

Overall Mortality

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Systematic review of the role of gender as a health determinant of hospitalization for depression

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646230400090x ◽

2004 ◽

Vol 20 (2) ◽

pp. 115-127 ◽

Cited By ~ 10

Author(s):

Isabelle Savoie ◽

Denise Morettin ◽

Carolyn J. Green ◽

Arminée Kazanjian

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Bipolar Disorders ◽

Primary Data ◽

Health Determinants ◽

Adult Women ◽

Health Determinant ◽

Hospitalization Rates ◽

Reported Data

Objectives:To conduct a systematic review of selected health determinants, including gender, and their impact on hospitalization rates for depression. Depression includes both depressive and bipolar disorders. Selected health determinants were gender, age, sex, family structure, education, and socioeconomic status.Methods:Systematic search of conventional and fugitive literature sources. All reports of primary data, systematic reviews, and meta-analysis of primary data were included if they focused on hospitalization for depression and reported data by one or more of the selected health determinants. Two researchers independently evaluated each citation for inclusion and extracted data from the included studies.Results:There is an important underreporting of health determinants data in studies of hospitalization for depression. No studies examined the role of gender. Age and sex were reported in 83 percent and 80 percent of the 110 included studies. Women showed a higher rate of hospitalization for depression than men (p<.05). Age and diagnosis had different effects in men and women. Adult women were significantly more likely than men to report a depressive disorder, whereas men were more likely to report a bipolar disorder (p<.05). Little can be concluded on the other health determinants.Conclusions:The importance of reporting hospitalization data and conducting hospital utilization analysis by sex and health determinants, including gender, must be emphasized.

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Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis

American Journal of Perinatology ◽

10.1055/s-0038-1668555 ◽

2018 ◽

Vol 36 (04) ◽

pp. 366-376 ◽

Cited By ~ 11

Author(s):

Richard Burwick ◽

Shravya Govindappagari

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Meta Analysis ◽

Oral Iron ◽

Sensitivity Analyses ◽

Deficiency Anemia ◽

Iv Iron ◽

Anemia In Pregnancy ◽

In Pregnancy

Objective To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the benefits of intravenous (IV) iron in pregnancy. Study Design Systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, MEDLINE, Web of Science, ClinicalTrials.gov, Cochrane Library, and Google Scholar were searched. Eleven RCTs, comparing IV to oral iron for treatment of iron-deficiency anemia in pregnancy, were included. Meta-analyses were performed with Stata software (College Station, TX), utilizing random effects model and method of DerSimonian and Laird. Outcomes were assessed by pooled odds ratios (OR) or pooled weighted mean difference (WMD). Sensitivity analyses were performed for heterogeneity. Results We found that pregnant women receiving IV iron, compared with oral iron, had the following benefits: (1) Achieved target hemoglobin more often, pooled OR 2.66 (95% confidence interval [CI]: 1.71–4.15), p < 0.001; (2) Increased hemoglobin level after 4 weeks, pooled WMD 0.84 g/dL (95% CI: 0.59–1.09), p < 0.001; (3) Decreased adverse reactions, pooled OR 0.35 (95% CI: 0.18–0.67), p = 0.001. Results were unchanged following sensitivity analyses. Conclusion In this meta-analysis, IV iron is superior to oral iron for treatment of iron-deficiency anemia in pregnancy. Women receiving IV iron more often achieve desired hemoglobin targets, faster and with fewer side effects.

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