Myint Phyo Thazin, Nandar Phoo Pwint, Thet Aye M, Orasanu Gabriela
Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
Department of Cardiology, Summa Health System, Akron, OH, USA.
Am Heart J Plus. 2022 Sep 12;22:100204. doi: 10.1016/j.ahjo.2022.100204. eCollection 2022 Oct.
Iron deficiency is an important co-morbidity in heart failure patients. IV iron may improve quality of life and reduce heart failure hospitalizations, but the results of the clinical trials are varied.
The purpose of this meta-analysis is to assess not only the effect of IV iron in iron-deficient heart failure patients but also the quality of evidence.
PubMed and Cochrane databases were searched from inception to Oct 2021. Randomized clinical trials in iron-deficient, heart failure patients assessing the effect of IV iron versus placebo and with at least 12 weeks of follow-up were included. The outcomes were pooled and analyzed using a random-effect model. The quality of evidence was assessed using the GRADE approach.
Seven studies were included in our meta-analysis. IV iron was associated with a 13.8 % decreased risk of HF hospitalizations (OR 0.59; 0.35-0.98, = 0.040, GRADE = Low). All-cause mortality and CV mortality were not different between IV iron and placebo. But a composite outcome of HF hospitalizations or CV mortality was 17.5 % lower with IV iron (OR 0.51;0.31-0.84, = 0.008, GRADE = Moderate).
Among heart failure patients with iron deficiency, IV iron is associated with lower HF hospitalizations. It is a relatively inexpensive regimen that can potentially improve quality of life and decrease healthcare expenditure.
缺铁是心力衰竭患者的一种重要合并症。静脉注射铁剂可能改善生活质量并减少心力衰竭住院次数，但临床试验结果各异。
本荟萃分析的目的不仅是评估静脉注射铁剂对缺铁性心力衰竭患者的疗效，还包括证据质量。
检索了从数据库建立至2021年10月的PubMed和Cochrane数据库。纳入了评估静脉注射铁剂与安慰剂对比效果、针对缺铁性心力衰竭患者且随访至少12周的随机临床试验。采用随机效应模型对结果进行汇总和分析。使用GRADE方法评估证据质量。
我们的荟萃分析纳入了7项研究。静脉注射铁剂与心力衰竭住院风险降低13.8%相关（OR=0.59；95%CI：0.35 - 0.98，P=0.040，GRADE=低）。静脉注射铁剂组与安慰剂组的全因死亡率和心血管死亡率无差异。但静脉注射铁剂组心力衰竭住院或心血管死亡的复合结局降低了17.5%（OR=0.51；95%CI：0.31 - 0.84，P=0.008，GRADE=中等）。
在缺铁性心力衰竭患者中，静脉注射铁剂与较低的心力衰竭住院率相关。这是一种相对便宜的治疗方案，有可能改善生活质量并降低医疗费用。
