Scientists found that giving a regular infusion of iron (ferric derisomaltose) to patients reduced their risk of hospitalization for heart failure or cardiovascular death by nearly 20 percent compared with those who did not receive the treatment. “This study adds to the evidence that heart failure patients should be routinely monitored for iron deficiency and be supplemented with iron if they’re deficient, because it will help to keep them out of the hospital and might even improve their life expectancy,” said Kiran Musunuru, MD, scientific director of the Center for Inherited Cardiovascular Disease at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, who discussed the study results at the American Heart Association Scientific Sessions held in November. Results were based on outcomes from 1,137 adults with heart failure and iron deficiency in the United Kingdom who were tracked for an average of two and a half years. Subjects had an average age of 73 years and nearly three-quarters were male. Patients were divided into two groups either receiving intravenous (IV) iron or not, in addition to standard care for heart failure. Standard care generally involves using traditional heart medications to treat heart failure, such as beta-blockers and ACE inhibitors. The IV iron group were given additional doses of iron at the one-month review and at follow-up visits conducted every four months thereafter if iron deficiency returned. In addition to lowering hospitalization and death risk among IV iron recipients, scientists noted that people in the IV iron group also reported improved well-being based on heart failure–related quality-of-life questionnaires when assessed at four months but not when reassessed at 20 months. “Despite several great therapeutic successes in recent decades, many people with heart failure still have symptoms that restrict their daily lives, and the rates of hospital admissions and mortality remain high,” says lead study author Paul Kalra, MD, a consultant cardiologist and heart failure specialist at Portsmouth Hospitals University National Health Service Trust in England and honorary senior lecturer at the University of Glasgow in Scotland. “There is an urgent need for new treatments that are safe and affordable.”
Why Is Iron So Vital?
Heart failure affects more than six million U.S. adults, according to the Centers for Disease Control and Prevention (CDC). Having the condition means the heart cannot pump enough blood and oxygen to support other organs in your body. The American College of Cardiology estimates that at least half of people with heart failure also have iron deficiency anemia (a condition in which blood lacks healthy red blood cells, per Mayo Clinic). Women and those patients who have more advanced heart failure or renal (kidney) dysfunction are at an increased risk for iron deficiency anemia. “Iron is critical for making new red blood cells which carry oxygen and when patients are iron deficient it leads to lower hemoglobin levels, reduces immunity, increases oxidation, and can change the metabolism of the heart,” says Forum Kamdara, MD, a cardiologist and assistant professor at the University of Minnesota Medical School in Minneapolis, who was not involved in the study. “Iron deficiency is also associated with a decrease in exercise capacity and quality of life.”
Taking Iron Via IV May Be More Effective Than Supplements
Study authors underscored that repeated dosing with IV iron is not only beneficial, but safe and well tolerated. By administering iron directly into a vein, iron levels can be quickly corrected. Dr. Kalra warned that taking iron orally may not be as effective because heart failure can sometimes impair the absorption of iron from the gut and the use of iron in the body. “Due to impaired absorption, oral iron may not correct iron deficiency, and if it does so, it might take many months to correct the problem,” says Kalra. “There are new oral iron preparations that are likely to be evaluated, but currently the data does not support evidence of benefit of oral iron.” Dr. Musunuru also pointed out that taking a lot of iron pills by mouth, day after day, is a lot less convenient than receiving occasional intravenous treatments. “A lot of patients have side effects with iron pills, particularly gastrointestinal symptoms, that don’t occur as much with intravenous iron,” he adds. Iron supplements can cause constipation, diarrhea, nausea, and stomach pains. Eating a healthy balanced diet with dietary iron sources along with foods high in vitamin C can help with iron absorption and maintain iron stores, notes Dr. Kamdara. Iron from meat is readily absorbed into the body, unlike nonmeat sources (from foods such as beans, lentils, tofu, dark leafy greens, whole grains, mushrooms, seeds, and nuts). Foods high in vitamin C (tomatoes, citrus fruits and red, yellow, and orange peppers, for example) can help with the absorption of plant-based iron. “Patients should only take oral iron supplements with the recommendation of their physician,” she says, cautioning that taking high levels of iron can also have negative effect on the heart. Excess iron in the heart affects the heart’s ability to circulate sufficient blood to meet the body’s needs, according to Mayo Clinic.
Iron May Play a Larger Role in Heart Disease
For the study, patient recruitment slowed or ceased during the COVID-19 pandemic in 2020 and 2021. Blood tests to detect recurring iron deficiency and redosing with iron were often impossible. To compensate, a further analysis was performed on the data from the 1,063 people who were part of the trial before March 31, 2020, and whose treatment wouldn’t have been as affected by the pandemic. There’s no doubt that further research into the mechanism of iron deficiency in heart failure and further clinical trials are necessary. More research could confirm whether IV iron treatment may also reduce mortality in people with heart disease and to help identify additional markers of iron deficiency to improve diagnostic accuracy. “People with heart failure are at risk of developing recurrent iron deficiency if their iron levels are not ‘topped up’ regularly,” says Kalra. “This study builds on existing evidence such that intravenous iron may benefit a broad range of people with heart failure, including those who are hospitalized, recently discharged, or attending office or out-patient clinic appointments.”
