Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Division of Cardiology, Department of Medicine, Karolinska Institutet; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
ESC Heart Fail. 2023 Apr;10(2):1473-1480. doi: 10.1002/ehf2.14310. Epub 2023 Feb 2.
There is considerable variability in the effect of intravenous iron on hard cardiovascular (CV)-related outcomes in patients with heart failure (HF) in randomized controlled trials (RCTs). We use a meta-analytic approach to analyse data from existing RCTs to derive a more robust estimate of the effect size of intravenous iron infusion on CV-related outcomes in patients with HF.
PubMed/Medline was searched using the following terms: ('intravenous' and 'iron' and 'heart failure') from inception till 6 November 2022 for RCTs comparing intravenous iron infusion with placebo or standard of care in patients with HF and iron deficiency. Outcomes were the composite of CV mortality and first hospitalization for HF; all-cause mortality; CV mortality; first hospitalization for HF; and total hospitalizations for HF. Random effects risk ratio (RR) with 95% confidence intervals (CIs) were calculated. Ten RCTs with a total of 3438 patients were included. Intravenous iron resulted in a significant reduction in the composite of CV mortality and first hospitalization for HF [RR 0.0.85; 95% CI (0.77, 0.95)], first hospitalization for HF [RR 0.82; 95% CI (0.67, 0.99)], and total hospitalizations for HF [RR 0.74; 95% CI (0.60, 0.91)] but no statistically significant difference in all-cause mortality [RR 0.95; 95% CI. (0.83, 1.09)] or CV mortality [OR 0.89; 95% CI (0.75, 1.05)].
Intravenous iron infusion in patients with HF reduces the composite risk of first hospitalization for HF and CV mortality as well as the risks of first and recurrent hospitalizations for HF, with no effect on all-cause mortality or CV mortality alone.
在随机对照试验（RCT）中，静脉铁剂对心力衰竭（HF）患者的硬心血管（CV）相关结局的影响存在相当大的差异。我们使用荟萃分析方法来分析现有 RCT 的数据，以更准确地估计静脉铁输注对 HF 患者 CV 相关结局的影响大小。
我们使用以下术语在 PubMed/Medline 中进行了搜索：（“静脉内”和“铁”和“心力衰竭”），从开始到 2022 年 11 月 6 日，以比较静脉铁输注与安慰剂或 HF 和缺铁患者的标准治疗。结局为 CV 死亡率和 HF 首次住院的复合结局；全因死亡率；CV 死亡率；HF 首次住院；HF 总住院。计算了 95%置信区间（CI）的随机效应风险比（RR）。共纳入 10 项 RCT，共计 3438 例患者。静脉铁治疗显著降低了 CV 死亡率和 HF 首次住院的复合结局 [RR 0.0.85；95%CI（0.77，0.95）]、HF 首次住院 [RR 0.82；95%CI（0.67，0.99）]和 HF 总住院 [RR 0.74；95%CI（0.60，0.91）]，但全因死亡率 [RR 0.95；95%CI（0.83，1.09）]或 CV 死亡率 [OR 0.89；95%CI（0.75，1.05）]无统计学差异。
HF 患者静脉铁输注可降低 HF 首次住院和 CV 死亡率的复合风险，以及首次和再次 HF 住院的风险，而对全因死亡率或 CV 死亡率无影响。
