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Iron Supplementation in HF: Trials Support IV but Not Oral

The issue of iron supplementation in patients with chronic heart failure remains unsettled after two new studies testing oral and intravenous iron yielded conflicting results at the American Heart Association 2016 Scientific Sessions.

Peak oxygen uptake (VO2) significantly improved when compared with standard of care after three intravenous injections of ferric carboxymaltose in HF patients with and without anemia in EFFECT-HF, while functional capacity and other outcomes failed to improve with a considerably cheaper oral iron supplement in the IRONOUT study. Iron deficiency is present in about half of patients with chronic HF and is an independent predictor of mortality.

Invited discussant Dr Stefan Anker (University Medicine Göttingen, Germany) said IRONOUT was an excellent trial done by expert teams, but the simple conclusion is that oral iron does not work in HF.

"Almost all of these patients have a resistance to the uptake of iron" that seems to be mediated by hepcidin, and "if iron can"t get into the body, you cannot expect it to work," he said.

Anker, who notably was also an EFFECT-HF investigator, said oral iron is given to thousands of patients with HF based on evidence from studies using intravenous iron. "This is not necessarily an evidence-based approach, and as you"ve seen now, it is an approach that may even be considered inappropriate."