IMPACT OF INTRAVENOUS IRON THERAPY IN PATIENTS WITH HEART FAILURE AND IRON DEFICIENCY: A SYSTEMATIC REVIEW
- 1Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brazil
Abstract
Introduction: Iron deficiency affects up to 50% of patients with chronic heart failure (HF) and is associated with worse outcomes, including reduced exercise capacity, poorer quality of life, and increased risk of hospitalization and mortality. As a prevalent comorbidity, several trials have investigated the effects of intravenous (IV) iron therapy in this population, showing positive results. However, its impact on mortality remains uncertain and it is unclear whether the observed benefits are driven by hemoglobin increases or by iron itself. These factors highlight the need for a comprehensive synthesis of the available evidence. Objectives: The aim of this study was to evaluate the effect of IV iron therapy on clinical outcomes in patients with heart failure and iron deficiency. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420261361606). PubMed, Cochrane and Embase databases were systematically searched using MeSH and DeCS terms, with no time restrictions up to March 2026. Randomized, non-randomized, and cohort studies including adults with heart failure and iron deficiency treated with intravenous iron were included. Comparators included placebo, standard therapy, or oral iron. Selection was performed by two reviewers with a third resolving disagreements. Results and Conclusion: A total of 10 studies were included after screening, comprising over 2,500 participants. Most studies were randomized controlled trials, evaluating patients with HF and iron deficiency, mainly with reduced ejection fraction. IV iron therapy was associated with improvements in functional capacity and quality of life in trials such as FAIR-HF and FERRIC-HF. A reduction in heart failure-related hospitalizations was also observed, notably in larger trials such as AFFIRM-AHF and IRONMAN. Regarding mortality, results were heterogeneous. While studies such as AFFIRM-AHF and IRONMAN suggested a trend toward reduction in cardiovascular outcomes, no consistent statistically significant reduction in all-cause mortality was observed across all included studies. Overall, IV iron therapy in patients with HF and iron deficiency is associated with improvements in functional status and a reduction in hospitalizations, particularly as demonstrated in trials such as AFFIRM-AHF and FAIR-HF, with a favorable safety profile. However, its impact on mortality remains uncertain. Further large-scale trials are needed to clarify long-term outcomes.
Related
- Intravenous iron supplementation in heart failure and iron deficiency: an umbrella review of systematic reviews and meta-analyses
- Development and external validation of a risk prediction model for early peripheral intravenous catheter failure in outpatients and emergency department patients receiving consecutive infusion therapy.
- Identifying Iron Deficiency and Opportunities for IV Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction: A Retrospective Cohort Study
- Association between early intravenous magnesium sulfate administration and mortality according to systemic immune-inflammation index in critically ill patients with acute heart failure: A retrospective cohort study.
- Digital and algorithmic strategies for guideline-directed medical therapy initiation and up-titration in adults with heart failure with reduced ejection fraction: a systematic review
BibTeX
@article{cunha2026impact,
title = {{IMPACT OF INTRAVENOUS IRON THERAPY IN PATIENTS WITH HEART FAILURE AND IRON DEFICIENCY: A SYSTEMATIC REVIEW}},
author = {Beatriz BARSI CUNHA and Lara DAMASCENO DUARTE and Maria Eduarda SANTOS DE OLIVEIRA and Clarissa FREIRE COUTINHO and Arthur BARROS MIRANDA CILIÃO LUCENA and Thaís FACÓ DE CASTRO and Fernanda DE CARVALHO SALES CAVALCANTE and Beatriz BARSI CUNHA and Letícia MATOS LEANDRO and Maria Beatriz MAGALHÃES PINTO and Victoria Stephane TESSARO},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.108488},
url = {https://doi.org/10.1016/j.htct.2026.108488},
note = {CC BY},
}
RIS
TY - JOUR
TI - IMPACT OF INTRAVENOUS IRON THERAPY IN PATIENTS WITH HEART FAILURE AND IRON DEFICIENCY: A SYSTEMATIC REVIEW
AU - Beatriz BARSI CUNHA
AU - Lara DAMASCENO DUARTE
AU - Maria Eduarda SANTOS DE OLIVEIRA
AU - Clarissa FREIRE COUTINHO
AU - Arthur BARROS MIRANDA CILIÃO LUCENA
AU - Thaís FACÓ DE CASTRO
AU - Fernanda DE CARVALHO SALES CAVALCANTE
AU - Beatriz BARSI CUNHA
AU - Letícia MATOS LEANDRO
AU - Maria Beatriz MAGALHÃES PINTO
AU - Victoria Stephane TESSARO
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.108488
UR - https://doi.org/10.1016/j.htct.2026.108488
AB - Introduction: Iron deficiency affects up to 50% of patients with chronic heart failure (HF) and is associated with worse outcomes, including reduced exercise capacity, poorer quality of life, and increased risk of hospitalization and mortality. As a prevalent comorbidity, several trials have investigated the effects of intravenous (IV) iron therapy in this population, showing positive results. However, its impact on mortality remains uncertain and it is unclear whether the observed benefits are driven by hemoglobin increases or by iron itself. These factors highlight the need for a comprehensive synthesis of the available evidence. Objectives: The aim of this study was to evaluate the effect of IV iron therapy on clinical outcomes in patients with heart failure and iron deficiency. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420261361606). PubMed, Cochrane and Embase databases were systematically searched using MeSH and DeCS terms, with no time restrictions up to March 2026. Randomized, non-randomized, and cohort studies including adults with heart failure and iron deficiency treated with intravenous iron were included. Comparators included placebo, standard therapy, or oral iron. Selection was performed by two reviewers with a third resolving disagreements. Results and Conclusion: A total of 10 studies were included after screening, comprising over 2,500 participants. Most studies were randomized controlled trials, evaluating patients with HF and iron deficiency, mainly with reduced ejection fraction. IV iron therapy was associated with improvements in functional capacity and quality of life in trials such as FAIR-HF and FERRIC-HF. A reduction in heart failure-related hospitalizations was also observed, notably in larger trials such as AFFIRM-AHF and IRONMAN. Regarding mortality, results were heterogeneous. While studies such as AFFIRM-AHF and IRONMAN suggested a trend toward reduction in cardiovascular outcomes, no consistent statistically significant reduction in all-cause mortality was observed across all included studies. Overall, IV iron therapy in patients with HF and iron deficiency is associated with improvements in functional status and a reduction in hospitalizations, particularly as demonstrated in trials such as AFFIRM-AHF and FAIR-HF, with a favorable safety profile. However, its impact on mortality remains uncertain. Further large-scale trials are needed to clarify long-term outcomes.
SN - 2531-1379
SN - 2531-1387
ER -