Peroral Ferrocorrection of Iron Deficiency in Patients With Chronic Heart Failure With Reduced Left Ventricular Ejection Fraction

Abstract

Therapy of iron deficiency as a common comorbidity in chronic heart failure is being paid much attention. It plays contributory role in the morbidity and mortality of heart failure. However, there are some questions requiring future research to answer them. Nowadays, the parenteral administration of iron supplements has been considered as one of the effective approaches for the correction of the above-mentioned disorders, although per oral rout of ferrum administration is playing the leading role. Among the disputable questions there is duration of peroral ferrocorrection course for patients with latent iron deficiency. Taking into account some disadvantages of per oral ferrocorrection, e.g. slow absorption in the gastrointestinal tract or reduced absorption in conditions of even minimal inflammation or blood congestion, in order to improve the condition of the patients with chronic heart failure and concomitant latent iron deficiency, we decided to prolong the course of therapy in our study. The purpose of the study was to determine the effectiveness of 6-month per oral ferrotherapy in patients with heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency. Material and methods. We examined 60 patients, 41 (68.3%) men and 19 (37.1%) women, aged 68.3 ± 0.63 years with chronic heart failure with reduced left ventricular ejection fraction functional class II-III according to NYHA, who were also diagnosed to have concomitant latent iron deficiency. Two study groups were formed: the patients of the 1st group (n=30) received only the standard therapy for chronic heart failure according to the European recommendations (2016); the patients of the 2nd group (n=30) were prescribed to take ferrous sulphate per orally in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid 2 tablets per day for 6 months. Results and discussion. By the study’s end, anaemia was observed in 76.5% of patients. However, among these patients, 84.6% had latent iron deficiency and only 15.4% had complete cure of the iron deficiency. Thus, it was found out that without supportive therapy with iron medicines for 32.8±0.7 months after the end of iron deficiency, patients with chronic heart failure had negative laboratory dynamics. Analysis of the dynamics of haematological indices as markers of the ferrocorrection effectiveness in the patients who received the 6-month ferrotherapy demonstrated an increase of all parameters and normalization of iron metabolism indices. Moreover, 96.7% of the patients, who took standard therapy and ferrum medicines, demonstrated the elimination of iron deficiency signs. Conclusion. Thus, the study showed that per oral therapy with iron sulphate at the stage of latent iron deficiency in patients with heart failure with reduced left ventricular ejection fraction for a period of 6 months has been found out as effective.