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Review
. 2025 Jul 29;17(7):e88989.
doi: 10.7759/cureus.88989. eCollection 2025 Jul.

Intravenous Iron Therapy in Patients Admitted With Acute Heart Failure and Iron Deficiency: A Systematic Review and Meta-Analysis

Victor Lopez  1 , Melissa Chacón  2 , María Jesús Arias  2 , Anthony Rojas  3 , Jessica Arias  2 , Paula Vanegas  2 , Fiorella Apuy Rodríguez  2 , Manuel E Saenz  4
Affiliations
Review

Intravenous Iron Therapy in Patients Admitted With Acute Heart Failure and Iron Deficiency: A Systematic Review and Meta-Analysis

Victor Lopez et al. Cureus. .

Abstract

The role of intravenous (IV) iron in chronic heart failure (HF) has been well studied, becoming a class IA recommendation. However, its role in acute heart failure (AHF) is less well-known. Multiple studies, including randomized controlled trials (RCTs), have been published; however, their clinical benefit remains controversial. We aim to provide enough evidence to support decision-making in this clinical scenario. We performed a systematic review and meta-analysis of IV iron in patients admitted with AHF and iron deficiency (ID). PubMed, Embase, Scopus, and Cochrane databases were searched for trials published up to July 1, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled across trials. Outcomes included HF and all-cause re-hospitalization, all-cause mortality, and mean change in hemoglobin levels. Of the 362 database results, three RCTs, six observational studies, and 3,588 patients were included. In total, 1,622 (45.2%) patients received IV iron. Re-hospitalization for HF (RR = 0.96; 95% CI = 0.76-1.21; p = 0.74; I² = 74%) showed a downward trend, but this was not statistically significant. Neither was all-cause rehospitalization (RR = 1.03; 95% CI = 0.90-1.19; p = 0.64; I² = 3%) nor all-cause mortality (RR = 1.00; 95% CI = 0.81-1.24; p = 0.87; I² = 0%). A statistically significant mean change in the hemoglobin levels (MD = 0.80; 95% CI = 0.33-1.27; p = 0.0003; I² = 88%) was documented between both groups. In patients with AHF and ID, treatment with IV iron improves hemoglobin levels. Yet, this improvement does not appear to have a significant impact on rehospitalization or all-cause mortality rates. Larger RCTs are needed to further study its effect on clinical outcomes.

Keywords: acute heart failure; intravenous iron; iron deficiency; mortality; rehospitalization.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram showing study screening and selection.
Figure 2
Figure 2. No statistically significant difference in heart failure rehospitalizations.
Figure 3
Figure 3. No statistically significant difference in all-cause rehospitalizations.
Figure 4
Figure 4. No statistically significant difference in all-cause mortality.
Figure 5
Figure 5. Statistically significant change in hemoglobin levels.
Figure 6
Figure 6. Leave-one-out sensitivity analysis for heart failure rehospitalizations.
Figure 7
Figure 7. Leave-one-out sensitivity analysis for all-cause rehospitalizations.
Figure 8
Figure 8. Leave-one-out sensitivity analysis for all-cause mortality.
Figure 9
Figure 9. Leave-one-out sensitivity analysis for hemoglobin change.
See this image and copyright information in PMC

References

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