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May Oral Iron Play a Role in HFrEF with Iron deficiency? A secondary analysis of IRONOUT HF Randomized Controlled Trial.
Session:
Best Posters
Speaker:
António Afonso Angélico Gonçalves
Congress:
CPC 2024
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 Leite; 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). Intravenous iron improves functional capacity and decreases the risk of cardiovascular hospitalizations. Treatment with oral iron has been scarcely studied and is not recommended. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To study patients according to changes in iron reserves, assess whether ID correction was associated with clinical outcomes and how treatment with oral iron influenced iron reserves.</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 the IRONOUT HF randomized placebo-controlled trial (RCT), which assessed the efficacy of treatment with oral iron for 16 weeks on functional capacity in 225 patients with HFrEF and ID. We divided the patients according to the transferrin saturation (TSat) change from baseline to end of follow-up (positive change: Improvers; neutral or negative change: Non-improvers). We conducted the following pre-specified analysis: (1) comparison of baseline variables of Improvers vs Non-improvers; (2) multivariate linear regression models evaluating the impact of TSat improvement in clinical outcomes; and (3) stepwise multivariate linear regression to assess how baseline variables and treatment with oral iron influenced iron reserves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Of the 186 patients that completed follow-up, 100 were considered Improvers and 86 were Non-improvers. Comparing to Non-improvers, Improvers had significantly lower baseline ferritin (75.8 vs 92.0 ng/mL, p=0.01), TSat (18.0 vs 24.7%, p<0.01) and hepcidin (7.1 vs 10.2 ng/mL, p<0.01). Forty-two percent of Non-improvers and 59% of Improvers received oral iron; the odds ratio for TSat improvement with oral iron was 2.0. Compared to Non-improvers, Improvers had a significantly higher Peak VO<sub>2</sub> change from baseline (β=0.64; CI95% 0.05–1.22 ml/kg/min). No differences were found in KCCQ-CSS score or 6-Min walk distance changes from baseline. In the multivariate linear regression model, baseline log transferrin saturations had a negative association (β=-11.3; CI95% -14.3 – -8,2) and treatment with oral iron had a positive association with TSat change from baseline (β=3.15; CI95% 0.79 – 5.5). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Patients with increased TSat had a clinically relevant Peak VO<sub>2</sub> increase. Adjusting for baseline TSat, oral iron resulted in a significant 3.15% increase in TSat. RCTs with optimized oral iron treatment and including patients with more severe ID may open a new role of oral iron in HFrEF with ID.</span></span></p>
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