Uncertainty remains about the effect of intravenous (IV) iron on outcomes for heart failure (HF) with iron deficiency. Here, we summarize the efficacy and safety of IV iron from six trials (FAIR-HF, CONFIRM-HF, AFFIRM-AHF, IRONMAN, HEART-FID, and FAIR-HF2) including 7,175 patients. In comparison to prior analyses, this meta-analysis adds new data from FAIR-HF2, uses a harmonized and robust Bayesian approach, and includes individual participant data from 5 trials. Patients assigned to IV iron, as compared to those assigned to placebo, had lower rates for the composite endpoint of recurrent HF hospitalizations and cardiovascular mortality at 12 months (RR 0.72 [95% CI 0.55–0.89]) and for the complete length of follow up (RR 0.81 [95% CI 0.63–0.97]). Each component of the primary endpoint contributed to the beneficial effect of IV iron at both 12 months and for the complete length of follow up: recurrent HF hospitalizations (RR 0.69 [95% CI 0.48–0.88] and RR 0.78 [95% CI 0.55–0.98], respectively) and cardiovascular mortality (HR 0.80 [95% CI 0.61–1.03] and HR 0.87 [95% CI 0.73–1.04], respectively). All-cause mortality at 12 months and for the complete length of follow up (HR: 0.82 [95% CI 0.65–1.03]) and 0.92 [95% CI 0.80–1.07], respectively) indicated the overall safety of IV iron treatment. Treatment effects were greatest in the first year after randomization when doses of IV iron provided are highest. These findings suggest that treating iron deficiency in patients with HF significantly reduces cardiovascular events and suggests further investigation of optimal dosing of IV iron.

静脉注射 （IV） 铁剂对缺铁心力衰竭 （HF） 结局的影响仍然存在不确定性。在这里，我们总结了六项试验 （FAIR-HF、CONFIRM-HF、AFFIRM-AHF、IRONMAN、HEART-FID 和 FAIR-HF2） 中静脉铁剂的疗效和安全性，包括 7,175 名患者。与之前的分析相比，该荟萃分析增加了来自 FAIR-HF2 的新数据，使用了协调和稳健的贝叶斯方法，并包括来自 5 项试验的个体参与者数据。与安慰剂组相比，静脉铁剂组患者在 12 个月时复发性 HF 住院和心血管死亡率的复合终点发生率 （RR 0.72 [95% CI 0.55–0.89]） 和完整随访时间 （RR 0.81 [95% CI 0.63–0.97]） 较低。主要终点的每个组成部分都有助于在 12 个月和整个随访期间静脉铁剂的有益效果：复发性 HF 住院（分别为 RR 0.69 [95% CI 0.48–0.88] 和 RR 0.78 [95% CI 0.55–0.98]）和心血管死亡率（HR 0.80 [95% CI 0.61–1.03] 和 HR 0.87 [95% CI 0.73–1.04]]。 分别）。12 个月和整个随访时间的全因死亡率 （HR： 分别为 0.82 [95% CI 0.65-1.03]） 和 0.92 [95% CI 0.80-1.07]）表明静脉铁剂治疗的总体安全性。随机分组后第一年的治疗效果最大，此时提供的静脉铁剂剂量最高。这些发现表明，治疗 HF 患者的铁缺乏症可显着减少心血管事件，并建议进一步研究静脉铁剂的最佳剂量。