Patients with heart failure (HF) often suffer from fatigue and other symptoms that affect quality of life. A new randomized trial suggests that intravenous iron (ferric carboxymaltose) improves symptoms in patients with HF and iron deficiency regardless of anemia status (level 1 [likely reliable] evidence). The trial compared ferric carboxymaltose 4 mL (200 mg elemental iron) intravenously vs. saline in 459 patients with HF who had New York Heart Association (NYHA) functional class II-III and iron deficiency. Iron was given weekly until repletion was achieved, then once every 4 weeks (beginning at week 8-12). Patients were followed for 24 weeks. The iron group was significantly more likely to report symptoms “much improved” or “moderately improved” on the Patient Global Assessment (50% vs. 28%, p < 0.001, NNT 5). Iron therapy was also associated with improvement in quality-of-life, the 6-minute walk test (p < 0.001), and NYHA functional class (class I or II in 47% vs. 30%, p < 0.001, NNT 6). Results were similar in subgroup analyses of patients with and without anemia (defined as hemoglobin ≤ 12 g/dL). There were no significant differences in rates of death or hospitalization. The iron group had a significantly lower rate of investigator-reported cardiac disorders (p = 0.01) and a marginally higher rate of gastrointestinal disorders (p = 0.06) (N Engl J Med. 2009 Dec 17;361(25):2436).

Ferric carboxymaltose (Ferinject) is not yet available in the United States, but it is approved in the United Kingdom and 17 other European countries.

For more information, see the Heart failure topic in DynaMed.