Intravenous Iron Linked to Reduced Risk of Heart Failure Hospitalisation

Sarfaroj Khan 


March 31, 2021


  • In patients with heart failure (HF) and iron deficiency (ID), intravenous (IV) iron reduced the risk of the composite outcome of first hospitalisations for heart failure (HHF) or cardiovascular (CV) mortality in the following 12 months.

  • However, this outcome was driven predominantly by an effect on HHF with no convincing evidence of a reduction in CV mortality.

Why this matters

  • The recent AFFIRM-AHF trial evaluating the effect of IV iron on outcomes in patients hospitalised with worsening HF who had ID narrowly missed its primary efficacy endpoint of recurrent HHF or CV mortality.

  • At least 3 more substantial trials of IV iron are underway.

Study design

  • Meta-analysis of 7 randomised controlled trials including 2166 patients with HF and ID (IV iron, n=1168; placebo, n=998).

  • Funding: None.

Key results

  • IV iron significantly reduced the composite outcome of HHF or CV death (OR, 0.73; 95% CI, 0.59-0.90; P=.003).

  • Outcomes were consistent for the pooled trials prior to AFFIRM-AHF.

  • HHF occurred in 175 (15%) patients administered IV iron vs 227 (23%) assigned to placebo (OR, 0.67; 95% CI, 0.54-0.85; P=.0007).

  • CV deaths occurred in 93 (8%) patients administered IV iron vs 98 (10%) assigned to placebo (OR, 0.89; 95% CI, 0.66-1.21; P=.47).


  • Study did not investigate the effect of IV iron on all-cause mortality as this is not yet reported for AFFIRM-AHF.


Graham FJ, Pellicori P, Ford I, Petrie MC, Kalra PR, Cleland JGF. Intravenous iron for heart failure with evidence of iron deficiency: a meta-analysis of randomised trials. Clin Res Cardiol. 2021 Mar 23 [Epub ahead of print]. doi: 10.1007/s00392-021-01837-8. PMID: 33755777.  View full text 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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