Abstract

Acute heart failure (AHF) represents one of the top causes of admission to emergency departments, and iron deficiency is one of the comorbidities that tend to result in poor clinical outcomes. Iintravenous (IV) iron supplementation is one of the therapies that has been proposed as an intervention to enhance functional recovery and decrease hospitalizations. A detailed search was carried out in accordance with PRISMA 2020 principles. The inclusion criteria were randomized and non-randomized trials that tested IV iron therapy in patients with presentations of AHF and iron deficiency. Random effects models were used to pool data, and the Cochrane Risk of Bias and Methodological Index of Non-Randomized Studies tools were used to evaluate the quality of studies. There were 10 studies that met the inclusion criteria. The overall analysis revealed that IV iron treatment was found to be significant in reducing heart failure (HF) hospitalization by 2% (OR = 0.72, 95% CI 0.56-0.93, p-value = 0.01) and the reduced hospital stay [standardized mean difference (SMD) = -0.81, 95% CI -1.08--0.54, p < 0.00001]. Yet, cardiovascular mortality (OR = 0.86, p-value = 0.31), readmissions/ED revisits (OR = 0.85, p-value = 0.20), and health-related quality of life (SMD = 0.37, p-value = 0.26) did not exhibit any significant effects. Iron-deficient AHF patients receiving intravenous iron therapy, especially ferric carboxylmaltose, show a significant reduction in the length of stay and HF admissions in the hospitals, suggesting that the patients recover better. Nonetheless, its impact on mortality, readmission, and the quality of life is unclear owing to the variability of the study.

Key words: Acute heart failure, iron deficiency, intravenous iron, ferric carboxymaltose, hospitalization, systematic review.