One of the researchers, Associate Professor David Sim of the National Heart Centre Singapore, with one of the participants in the study, Madam Sumuthi Nadesan. (Image Source: NHCS)

  • A study was done from 2017 to 2020 in 15 countries including Singapore
  • It found that iron therapy led to a reduction in heart failure hospitalisation
  • Iron deficiency is common among those with acute heart failure

SINGAPORE — Heart failure patients who are treated with intravenous iron therapy are 26 per cent less likely to be re-admitted to the hospital for heart failure compared to those who were not given the therapy, a global study in which Singapore participated has found.

However, the researchers cautioned that even with iron therapy, patients remain at risk of heart failure and so a variety of treatments should be employed to manage the risks of readmission.

Iron therapy is a procedure in which iron compounds are delivered through to the body into the vein through a needle.

Iron deficiency is common among those with acute heart failure, with 60 per cent of heart failure patients in Singapore being iron-deficient.

Global estimates showed that heart failure patients who are also iron-deficient are about 30 to 40 per cent more likely to have recurrent hospitalisation incidences within half a year, and are at a higher risk of death.

The international study was conducted from March 2017 to July 2020 by researchers from the National Heart Centre Singapore (NHCS) and partners in Europe, the Middle East and South America.

It analysed outcomes of intravenous iron therapy in 1,100 heart failure patients with iron deficiency. The patients came from 15 countries in Asia, Europe, Middle East and South America.

Of those participants, 58 were from Singapore, which was the only Asian country to take part in the trial. The majority of the participants were older male patients in their 70s.

The data was not broken down by country as it was analysed based on the total cohort of all participants.

Not all patients received the iron therapy. Some received a placebo as part of the trial.

The randomised clinical trial studied the efficacy and safety outcomes of intravenous iron therapy — using the compound ferric carboxymaltose — on morbidity and mortality for these groups of patients.

The study found that there was a reduction in total heart failure hospitalisation, with those given the therapy 26 per cent less likely to be re-admitted to the hospital for heart failure within a year compared to those who were given the placebo.

For mortality rates, however, the study found that there was no significant difference.

Weighing in on the findings, Associate Professor David Sim, who was one of the researchers, said the results suggested that iron therapy can be used to give heart failure patients a better quality of life and lessen their financial burden by reducing their re-admission rates to the hospital.

Even so, Assoc Prof Sim noted that there is still a high risk of re-admission for heart failure even with the new findings on intravenous iron therapy.

“So to reduce the chance of re-admission, treatments have to be targeted at different clinical pathways such as other heart failure medications, (as well as) approaches including lifestyle modifications like fluid restriction and a low-salt diet,” he said.

With the findings from the clinical trial, the NHCS has moved to implement new guidelines on how to identify and treat iron deficiency in patients with heart failure.

These patients can be identified with a simple blood test, Assoc Prof Sim said. He is also the director of the heart failure programme at NHCS.

The intravenous treatment lasts around 10 to 15 minutes and can be performed in any hospital ward.

About 80 per cent of patients in the trial needed only one or two doses within a year, Assoc Prof Sim said.

He added that patients who are assessed to have a low iron count months or years down the line may receive a top-up dose of the therapy.

The cost of the drug before subsidy is slightly over S$100 for each vial, the NHCS said in response to TODAY’s queries. However, as the drug is under the Ministry of Health’s standard drug list of subsidised drugs, subsidies are available for eligible patients.

Madam Sumuthi Nadesan, who was one of the patients involved in the clinical study here, said that she has not returned to the hospital since she received the iron therapy treatment in 2018.

The 61-year-old patient care assistant was diagnosed with heart failure in 2010 and said that she usually gets re-admitted to the hospital at least twice each year due to overconsumption of liquids.

When asked if she was worried about her condition, she said: “No, I’m not worried because I got a good treatment.”