Name:
Heart Failure Complicated by Iron Deficiency
Description:
Heart Failure Complicated by Iron Deficiency
Thumbnail URL:
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Duration:
T00H04M17S
Embed URL:
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Content URL:
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's, The Heart Board Review, and other online resources available only through accesscardiology.com. >> Heart failure, as is well-documented, is increasing as our population is aging and is associated with poor prognosis. We continue to be challenged to find other contributing risk factors that would allow for additional treatment to improve the poor prognosis.
[ Music ] Hi, I'm Dr. Bernie, and welcome to Practice Impact Extra. Does iron replacement help heart failure patients? Previous trials including FAIR-Heart Failure, CONFIRM-Heart Failure, and EFFECT-Heart Failure demonstrated IV iron supplementation improved exercise capacity, symptoms, and quality of life in iron-deficient heart failure patients.
Iron deficiency in certain studies is thought to be present in up to 70% of patients with acute heart failure and is a predictor of poor outcome, and that's independent of anemia and the ejection fraction. The AFFIRM-Acute Heart Failure trial was published in Lancet in November 2020 and set its goal to evaluate intravenous ferric carboxymaltose among patients hospitalized for acute heart failure and iron deficiency, and they compared that with a placebo.
The trial enrolled 1,132 patients who were hospitalized for acute heart failure. All patients had iron deficiency, which was defined as a serum ferritin level of less than 100 nanograms per milliliter or a transferrin saturation level less than 20%. The average dose of ferric carboxymaltose was 1,350 milligrams with 80% of patients having a resolution in their iron-deficient state. The average ejection fraction of the 1,100 patients enrolled was 33%.
The trial was double-blinded. Patients either received a bolus injection of carboxymaltose or normal saline before discharge from the hospital. Subsequent treatment with ferric carboxymaltose was given as needed for up to 24 weeks post-randomization. So, what were the findings at 52 weeks? The primary outcome, total heart failure hospitalization and cardiovascular death within 52 weeks, occurred in 52% of the ferric carboxymaltose group compared to 67% of the placebo group.
What about secondary outcomes? Cardiovascular death. It didn't seem that it was significantly different between the iron replacement group, the ferric carboxymaltose group, compared to the 14% of the placebo group. Total heart failure hospitalization was 49% in the ferric iron replace group compared to 53% in the placebo group. Treatment with ferric carboxymaltose was safe and well-tolerated without a difference in adverse events in the two groups.
This trial was somewhat limited and subject to some interpretation because data was accumulated pre and post COVID for analysis and enrollment, and results may have been somewhat less complete. However, the take-home message here that the endpoints of this trial are important. And I believe we have to start thinking about iron deficiency in patients who are stabilized for acute heart failure. Thank you for joining me and see you next time on Practice Impact Extra.
>> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
