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Role of oral iron in HFrEF and decreased transferrin saturation: A Secondary analysis of IRONOUT-HF.
Session:
SESSÃO DE POSTERS 43 - INSUFICIÊNCIA CARDÍACA E COMORBILIDADES
Speaker:
António Afonso Angélico Gonçalves
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
António Afonso Angélico Gonçalves; Ana Rita Ferreira Leite; Pedro Marques; Adelino Leite Moreira; João Pedro Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Iron deficiency (ID) associates with high morbimortality in patients with heart failure with reduced ejection fraction (HFrEF). Ferritin may not be an accurate discriminator of ID and a new definition of ID including only decreased (<20%) transferrin saturation (TSat) has been proposed. Patients decreased TSat may experience clinical improvement from oral iron.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>Assess the effects of oral iron compared to placebo in HFrEF patients with decreased TSat (<20%) on iron biomarkers, functional capacity and quality of life. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We used patient-level data from IRONOUT-HF randomized placebo-controlled trial (RCT), which assessed the efficacy of treatment with oral iron or placebo for 16 weeks on functional capacity in 225 patients with HFrEF and ID. We performed a secondary analysis, including only patients with decreased (<20%) TSat at baseline. We assessed differences between patients treated with oral iron and placebo in (1) baseline characteristics using T-test for independent samples or Mann-Whitney U tests, (2) baseline to end-of-follow-up differences in hemoglobin, iron biomarkers and functional capacity using multivariate linear regressions. For each independent variable, the predictor variables used were treatment allocation and respective baseline variable.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Out of 225 patients included in the original trial, 108 had decreased TSat at baseline of which 54 received placebo and 54 received oral iron. Patients treated with oral iron, when compared to placebo, had similar age (62.2 vs 61.5 years), sex (61% vs 69% male), left ventricle ejection fraction (24.8 vs 26.3%), peak VO2 uptake (12.7 vs 12.3 ml/kg/min), baseline hemoglobin (12.1 vs 12.3 g/dL), baseline ferritin (79.5 vs 52.5 ng/mL), baseline TSat (16.0 vs 14.0%) and baseline hepcidin (4.92 vs 5.11 ng/mL) – all p values > 0.1. Compared to placebo, treatment with oral was not associated with baseline to end-of-follow-up changes in ferritin (mean absolute difference [MAD] 5.0 ng/mL, p=0.552, 95% CI -13.8 to 20.4), TSat (MAD 2.24%, p=0.135, 95% CI - 0.71 to 5.19) or peak VO2 (MAD 0.69 ml/kg/min, p=0.079, 95% CI -0.08 to +1.46).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> In HFrEF patients with decreased TSat, treatment with oral iron for 16 weeks was not associated with a significant improvement in TSat or ferritin and only showed a trend for improvement on functional capacity. Benefit from Ooal iron in HFrEF and ID remains uncertain and intravenous iron should be preferred.</span></span></p>
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