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Meta-Analysis
. 2024 Dec;44(12):879-896.
doi: 10.1007/s40261-024-01401-y. Epub 2024 Nov 11.

Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients

Amira Mohamed Taha  1 , Ahmed Saad Elsaeidy  2 , Sarah A Nada  3 , Sadish Sharma  4 , Mohamed M Ghonaim  5 , Areeba Ahsan  6 , Marina Ramzy Mourid  7 , Khaled Abouelmagd  8
Affiliations
Meta-Analysis

Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients

Amira Mohamed Taha et al. Clin Drug Investig. 2024 Dec.

Abstract

Background: Iron deficiency is prevalent among heart failure patients and is associated with worse clinical outcomes, including decreased quality of life and functional capacity. This condition often results in a higher incidence of hospitalization and mortality. Iron supplementation, particularly with intravenous ferric carboxymaltose (FCM), has shown potential benefits as an adjunct therapy in heart failure management. This study aims to evaluate the efficacy of FCM in the treatment of patients with heart failure and iron deficiency anemia, with a focus on its impact on mortality and hospitalization rates.

Methods: A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from their inception until 1st December 2023. Meta-analysis was performed using RevMan 5.4, employing a random-model effect. The results were reported as risk ratios (RRs), standard mean differences (SMDs), and 95 % confidence intervals (CIs).

Results: The meta-analysis included 13 studies with a total of 6271 patients. Ferric carboxymaltose administration resulted in a significant improvement in the 6-minute walk distance (SMD: 1.45; 95 % CI: 0.55, 2.36; p = 0.002), quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD: 1.49; 95 % CI: 0.87, 2.11; p < 0.00001), the rate of first hospitalization for heart failure or cardiovascular death (RR: 0.91; 95 % CI: 0.84, 0.98; p = 0.02). However, FCM did not show a significant impact on the risk of cardiovascular death (RR: 0.90; 95 % CI: 0.77, 1.05; p = 0.17), the need for intervention due to worsening heart failure (RR: 0.41; 95 % CI: 0.04, 4.51; p = 0.47), or all-cause mortality rates (RR: 0.89; 95 % CI: 0.69, 1.16; p = 0.28).

Conclusion: While FCM treatment in patients with heart failure and iron deficiency anemia significantly improves functional capacity and quality of life, it has no notable effect on mortality rates or the likelihood of hospitalization. These findings highlight the need for further research to explore comprehensive treatment strategies that address both the symptomatic and survival aspects of heart failure management in this patient population.

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Conflict of interest statement

Declarations. Author Contributions: A.M.T. conceived the idea. A.M.T. designed the research workflow. S.A.N., S.S., M.M.G., A.A., M.R.M. and K.A. searched the databases. S.A.N., S.S., M.M.G., A.A., M.R.M. and K.A. screened the retrieved records, extracted relevant data, assessed the quality of evidence, and A.M.T. and A.S.E. resolved the conflicts. A.A. performed the analysis. A.S.E., S.A.N., S.S., M.M.G., A.A., M.R.M., and K.A. wrote the final manuscript. A.M.T. and A.S.E. supervised the project. All authors have read and agreed to the final version of the manuscript. Conflicts of Interest: The authors declare no conflict of interest. Funding: We received no funding for this study. Ethics Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable. Availability of Data and Materials: Not applicable. Code Availability: Not applicable.

Figures

Fig. 1
Fig. 1
The preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram
Fig. 2
Fig. 2
Cochrane risk-of-bias quality assessment of randomized clinical trials (ROB-II)
Fig. 3
Fig. 3
Forest plot of the effect of FCM on the 6-min walk distance. 6-MWT 6-minute walk test, CI confidence interval, df degree of freedom, FCM ferric carboxymaltose, IV inverse variance, SD standard deviation
Fig. 4
Fig. 4
A Forest plot of the effect of FCM on EQ-5D visual analog scale, and B Kansas City Cardiomyopathy Questionnaire (KCCQ) at 4, 12, and 24 weeks. 6-MWT 6-minute walk test, CI confidence interval, df degree of freedom, FCM ferric carboxymaltose, IV inverse variance, SD standard deviation
Fig. 5
Fig. 5
A Forest plot of the effect of FCM on the incidence of first hospitalization for heart failure or cardiovascular death, and B the incidence of first hospitalization due to heart failure. CI confidence interval, df degree of freedom, FCM ferric carboxymaltose, IV inverse variance
Fig. 6
Fig. 6
A Forest plot of the effect of FCM on cardiovascular death, and B death or the need for intervention due to worsening heart failure. CI confidence interval, df degree of freedom, FCM ferric carboxymaltose, IV inverse variance
Fig. 7
Fig. 7
Forest plot of the effect of FCM on all-cause death. CI confidence interval, df degree of freedom, FCM ferric carboxymaltose, IV inverse variance
See this image and copyright information in PMC

References

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