Pumping Irons: IV Supplements Help Patients With Heart Failure

Heart failure patients diagnosed with iron deficiency appear to avoid returning to the hospital if treated with intravenous iron carboxymaltose to supplement iron stores. American Heart Association Virtual 2020 Science Session..

In Affirmation-AHF trialPatients treated with carboxymaltose ferric showed a 21% relative risk reduction at the major composite endpoint of hospitalization and cardiovascular death when compared to patients receiving placebo ()P= 0.059), reported by Piotr Ponikowski, MD, PhD, Wroclaw Medical College, Poland.

The results were driven primarily by reduced hospitalization – which achieved statistical significance with a 26% relative risk reduction (P= 0.013). This result was achieved with one or two injections in 80% of patients in the ferric carboxymaltose group, Ponikowski said at an AHA press conference.

He said the COVID-19 epidemic affected the trial, and researchers performed a holistic analysis as well as a sensitivity analysis based on pre-pandemic results. This COVID-19 and earlier analysis found 25% relative risk reduction for key endpoints that achieved statistical significance (P= 0.024).

“Treatment with carboxymaltose ferric was safe and well tolerated,” Ponikowski said. “Sensitivity analysis prior to COVID-19 revealed a statistically significant difference in favor of carboxymaltose ferric for primary and secondary endpoints. Heart failure and left ventricular ejection rate. When less than 50% of patients receive carboxymaltose ferric, acute heart failure reduces the risk of subsequent hospitalization for heart failure. “

The Affirm-AHF trial enrolled 1,108 patients in 15 countries who were discharged from hospital for acute heart failure and were found to have iron deficiency during hospitalization. The average age of the participants was 71 years, 56% were male, and the average cardiac ejection fraction was 33%.

After the heart condition stabilized, the patient received either intravenous carboxymaltose ferric, given depending on the level of iron deficiency, or a placebo infusion for the next 24 weeks.

“This was the first study to demonstrate the benefits of iron supplementation initiated in stable patients hospitalized for acute heart failure, and the majority of patients required only two doses,” Ponikowski said. .. “Healthcare professionals need to screen patients with heart failure for the presence of iron deficiency, and consider intravenous iron for patients with iron deficiency and ejection fractions of 50% or less.”

Nancy Switzer, MD, MD, AHA debater at the University of Arizona at Tucson, said the study was likely to change treatment guidelines.

“This study shows that intravenous administration of ferric carboxymartose to iron deficient patients hospitalized for heart failure in more than 1,100 patients reduces subsequent hospitalizations without affecting mortality. “She said.

She said Affirm-AHF “targeted one of the highest-risk populations of heart failure.” She said patients with heart failure and iron deficiency tend to be older, have more comorbidities, have longer hospital stays, and are more likely to be readmitted due to complications of heart failure.

Dr. Clyde Yancy, MD, a press conference moderator at Northwestern University School of Medicine in Chicago, said the study clearly showed signs of efficacy with iron supplementation, but of studies related before and after COVID. I also questioned the results. analysis. “This is the reality of today, and we need to make very intelligent decisions based on the patient in front of us, how we interpret the data, and whether we do this and incorporate it,” Yancy said. I will. Today’s MedPage..