Intravenous iron treatment in patients with heart failure and iron deficiency: IRONMAN

2016 ◽  
Author(s):  
Elizabeth Thomson
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Intravenous Iron ◽  
Iron Treatment ◽  
Patients With Heart Failure

scholarly journals Monitoring of iron status in patients with heart failure

2019 ◽  
Vol 21 (Supplement_M) ◽  
pp. M32-M35 ◽  
Author(s):  
Ewa A Jankowska ◽  
Michał Tkaczyszyn ◽  
Marcin Drozd ◽  
Piotr Ponikowski
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Serum Ferritin Level ◽  
Iron Status ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
Intravenous Iron ◽  
Accurate Method ◽  
Separate Entity ◽  
Patients With Heart Failure

Abstract The 2016 ESC/HFA heart failure (HF) guidelines emphasize the importance of identifying and treating iron deficiency (ID) in patients with HF. Iron deficiency can occur in half or more of HF sufferers, depending on age and the phase of the disease. Iron deficiency can be a cause of anaemia, but it is also common even without anaemia, meaning that ID is a separate entity, which should be screened for within the HF population. Although assessment of iron stores in bone marrow samples is the most accurate method to investigate iron status, it is not practical in most HF patients. Levels of circulating iron biomarkers are an easily available alternative; especially, ferritin and transferrin saturation (Tsat). In patients with HF serum ferritin level <100 µg/L (regardless of Tsat value) or between 100 and 299 µg/L with Tsat <20% are considered as recommended criteria for the diagnosis of ID, criteria which have been used in the clinical trials in HF that have led to a recommendation to treat ID with intravenous iron. We discuss the optimal measures of iron biomarkers in patients with HF in order to screen and monitor iron status and introduce some novel ways to assess iron status.

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

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

Iron Deficiency and Heart Disease: Ironclad Evidence?

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 348-350 ◽  
Author(s):  
Jeffrey L. Carson ◽  
John W. Adamson
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Iron Deficiency ◽  
Hemoglobin Concentration ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
Mild Anemia ◽  
Iron Treatment ◽  
Objective Outcomes ◽  
Anemia Of Chronic Inflammation

Abstract Patients with heart failure have elevated levels of circulating inflammatory cytokines and commonly have iron deficiency anemia or anemia of chronic inflammation. Clinical trials in patients with congestive heart failure and iron deficiency have demonstrated that intravenous iron treatment appears to improve subjective and objective outcomes. Most patients in these trials were not anemic or only had mild anemia, and hemoglobin concentration rose only slightly after treatment with iron. Experimental evidence demonstrates that iron is a cofactor for muscle function, which could explain the improvement in clinical outcomes. Many questions remain to be answered to understand the role of iron therapy in patients with congestive heart failure.

scholarly journals Why is Iron Deficiency Recognised as an Important Comorbidity in Heart Failure?

2019 ◽  
Vol 5 (3) ◽  
pp. 173-175 ◽  
Author(s):  
Nicole Ebner ◽  
Stephan von Haehling
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Iron Deficiency ◽  
Trace Element ◽  
Iron Metabolism ◽  
Experimental Studies ◽  
Intravenous Iron ◽  
Iron Therapy ◽  
Patients With Heart Failure ◽  
Long Time

There is an increasing awareness of the prevalence of iron deficiency in patients with heart failure (HF), and its contributory role in the morbidity and mortality of HF. Iron is a trace element necessary for cells due to its capacity to transport oxygen and electrons. The prevalence of iron deficiency increases with the severity of HF. For a long time the influence of iron deficiency was underestimated, especially in terms of worsening of cardiovascular diseases and developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and HF showed new insights into the improvement of iron therapy. Additionally, experimental studies supporting the understanding of iron metabolism and the resulting pathophysiological pathways of iron have been carried out. The aim of this mini review is to highlight why iron deficiency is recognised as an important comorbidity in HF.

scholarly journals Intravenous iron is non-inferior to oral iron regarding cell growth and iron metabolism in colorectal cancer associated with iron-deficiency anaemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hafid O. Al-Hassi ◽  
Oliver Ng ◽  
Rayko Evstatiev ◽  
Manel Mangalika ◽  
Natalie Worton ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Iron Deficiency ◽  
Iron Metabolism ◽  
Iron Deficiency Anaemia ◽  
Iron Transport ◽  
Intravenous Iron ◽  
Oral Iron ◽  
Iron Loading ◽  
Deficiency Anaemia ◽  
Iron Treatment

AbstractOral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examined whether the route of iron therapy alters iron transport and tumour growth. Colorectal adenocarcinoma patients with pre-operative iron deficiency anaemia received oral ferrous sulphate (n = 15), or intravenous ferric carboxymaltose (n = 15). Paired (normal and tumour tissues) samples were compared for expression of iron loading, iron transporters, proliferation, apoptosis and Wnt signalling using immunohistochemistry and RT-PCR. Iron loading was increased in tumour and distributed to the stroma in intravenous treatment and to the epithelium in oral treatment. Protein and mRNA expression of proliferation and iron transporters were increased in tumours compared to normal tissues but there were no significant differences between the treatment groups. However, intravenous iron treatment reduced ferritin mRNA levels in tumours and replenished body iron stores. Iron distribution to non-epithelial cells in intravenous iron suggests that iron is less bioavailable to tumour cells. Therefore, intravenous iron may be a better option in the treatment of colorectal cancer patients with iron deficiency anaemia due to its efficiency in replenishing iron levels while its effect on proliferation and iron metabolism is similar to that of oral iron treatment.

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