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The following is a summary of “Adjudication of Hospitalizations and Deaths in the IRONMAN Trial of Intravenous Iron for Heart Failure,” published in the October 2024 issue of Cardiology by Cleland et al.
Patients with heart failure (HF) and iron deficiency often face multiple causes of hospitalization and death that may be influenced by intravenous iron repletion.
Researchers conducted a prospective study to examine causes of hospitalizations and deaths among patients with HF who received intravenous ferric derisomaltose (FDI) compared to those receiving usual care.
They enrolled patients with HF, left ventricular ejection fraction ≤45%, and either transferrin saturation <20% or serum ferritin <100 μg/L, with a median follow-up of 2.7 years (Q1-Q3: 1.8-3.6 years). A committee adjudicated primary and contributory causes of unplanned hospitalizations and deaths, and rate ratios (RRs) for selected recurrent events with 95% CIs were reported.
The results showed that compared with usual care, patients randomized to FDI had fewer unplanned hospitalizations (RR: 0.83; 95% CI: 0.71-0.97; P=0.02). Reductions were observed in both cardiovascular (CV) (RR: 0.83; 95% CI: 0.69-1.01) and non-CV (RR: 0.83; 95% CI: 0.67-1.03) hospitalizations, as well as hospitalizations for HF (RR: 0.78; 95% CI: 0.60-1.00), respiratory disease (RR: 0.70; 95% CI: 0.53-0.97), and infection (RR: 0.82; 95% CI: 0.66-1.03), HF was the primary cause of 26% of hospitalizations and contributed to or complicated 12% more. Infection caused or contributed to 38% of all hospitalizations, including 27% of those related to HF, CV, and all-cause mortality rates were similar between the FDI and usual care groups.
They concluded that intravenous FDI was associated with similar reductions in CV and non-CV hospitalizations, potentially enhancing resilience to various causes of hospitalizations in patients with HF with iron deficiency.