The IRONMAN randomized clinical trial reported that treatment with intravenous iron for individuals with heart failure and iron deficiency resulted in a lower risk of hospital admissions for heart failure and cardiovascular death. The results were published in The Lancet.
Iron deficiency is common in all geographical areas, both genders and all age groups. Intravenous iron can provide a rapid treatment option that is often superior to oral iron. See our webpage on intravenous iron for more details.
Iron deficiency, with or without anemia, is frequently associated with chronic heart failure. Over 64 million people suffer from chronic heart failure worldwide, and 30-50% have iron deficiency. Additionally, medications used to treat chronic heart failure, such as angiotensin receptor blockers and anticoagulants, increase the risk of anemia. Anemia and iron deficiency are underdiagnosed in patients with chronic heart failure, but have serious consequences. They can lead to fatigue, feeling out of breath, reduced physical performance, and worse outcomes like hospitalization or death.
1. Paul BT, et al. 2017; doi:10.1080/17474086.2016.1268047; 2. Paterek A, et al. 2019; doi:10.1002/jcp.28820; 3. Klip IT, et al. 2013; doi.org/10.1016/j.ahj.2013.01.017; 4. Comín-Colet J, et al. 2011; doi:10.1016/j.cardfail.2011.08.003; 5. McDonagh TA, et al. 2021; doi:10.1093/eurheartj/ehab368.
Treating iron deficiency in those with heart failure is critical. Intravenous iron is recommended, as oral therapy is ineffective at restoring iron levels. Oral iron has also been reported to cause gastric upset in more than half of heart failure patients. Several small clinical trials have indicated the effectiveness of intravenous iron treatment. A meta-analysis reported a reduction in hospitalizations and cardiovascular mortality in patients with chronic heart failure and iron deficiency after treatment with IV ferric carboxymaltose.
The IRONMAN clinical trial was the first large, randomized trial to investigate safety and the long-term effect of repeated administration of a different intravenous iron (ferric derisomaltose). This form of iron can be given in higher doses and is commonly used in other areas of medicine. The trial enrolled 1137 participants with heart failure, reduced ejection fraction, and iron deficiency, and those receiving intravenous iron had a lower risk of hospital admissions for heart failure and cardiovascular death.
If you have been diagnosed with heart failure, be sure that you have been checked for iron deficiency. This includes hemoglobin levels, ferritin concentration, and transferrin saturation (also called TSAT).
