TREATING IRON DEFICIENCY IN HEART FAILURE PATIENTS IMPROVES HEALTH OUTCOMES AND REDUCES MORTALITY

• A multinational trial by researchers from the National Heart Centre Singapore and partners has shown that iron therapy significantly reduces re-hospitalisation and provides better health outcomes in patients with heart failure.
  
  
• Research findings have translated into clinical practice in NHCS, as part of the overall treatment strategy for patients with heart failure, for improved patient care.

Singapore, 23 March 2021 – In a recent multinational trial – AFFIRM-AHF, researchers from the National Heart Centre Singapore (NHCS) together with partners in Europe, Middle East, South America, affirmed that iron therapy significantly reduces heart failure hospitalisation and mortality in patients with acute heart failure (HF).

Iron deficiency is a common comorbidity in patients with HF and is highly prevalent (approximately 80 percent) in acute HF cases¹. Iron deficiency in patients with HF will lead to diminished exercise capacity and heart function, resulting in diminished quality of life and poor health outcomes. Such HF cases were found to have 30 to 40 percent of recurrent hospitalisation incidences within half a year², and with higher risks of morbidity and mortality.

“There have been significant heart failure cases complicated with iron deficiency, resulting in poor quality of life and composite outcomes, with higher risk of hospitalisation and deaths,” said Associate Professor David Sim, Director of Heart Failure Programme from NHCS, and the National Coordinator for Singapore in AFFIRM-AHF. “About 30 percent of stable HF patients and 50 percent of hospitalised patients are found to have anaemia³. Therefore, it is crucial to identify this comorbidity in HF patients, as some can also be iron deficient without being diagnosed with anaemia.”

Conducted from March 2017 to July 2020 in 121 sites, AFFIRM-AHF is the first randomised clinical trial to evaluate the effect of intravenous (IV) ferric carboxymaltose on morbidity and mortality in patients with iron deficiency and acute heart failure. The trial studied the efficacy, safety and outcomes of iron therapy, that involves the administering of IV iron, IV ferric carboxymaltose, relative to a placebo, in the treatment of 1,100 patients with HF and iron deficiency over a period of one year.

Results from AFFIRM-AHF have shown that heart failure hospitalisations were significantly reduced in patients who are stabilised after acute HF and concomitant iron deficiency. These findings have also been translated into recommendations for clinical practice in NHCS, where specific guidelines are implemented to identify and treat iron deficiency in patients with heart failure. “We are happy that our research findings have been translated into clinical practice, as part of the overall treatment strategy for patients with HF, so that patients can lead a better quality of life and reduce their re-admissions to hospitals,” said Associate Professor David Sim, who is also a Senior Consultant from the Department of Cardiology at NHCS.

Research findings were published in several high impact scientific journals including The Lancet.

References:

• ¹Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Göhring UM, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, et al.; AFFIRM-AHF investigators. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020 Dec 12;396(10266):1895-1904. doi: 10.1016/S0140-6736(20)32339-4. Epub 2020 Nov 13. PMID: 33197395. 
• ²Ponikowski P, Kirwan BA, Anker SD, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Haboubi T, Keren A, Khintibidze I, Kragten H, Martinez FA, McDonagh T, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, et al. Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure. Eur J Heart Fail. 2019 Dec;21(12):1651-1658. doi: 10.1002/ejhf.1710. 
• ³Inder S. Anand Inder S, and Gupta Pankaj. Anaemia and Iron deficiency in Heart failure. Circulation 2018; 138: 80-98. doi: 10.1161/circulationaha.118.030099