The importance of dose optimisation in the treatment of iron deficiency in heart failure

Martens, Pieter; Minten, Lennert; Dupont, Matthias; Mullens, Wilfried

doi:10.1080/00015385.2019.1625554

Cited by 8 publications

(8 citation statements)

References 9 publications

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“…Although the difference between these two groups did not reach significance in our study, this observation is consistent with the findings of a similar real-world study in patients with ID and heart failure-patients who were dosed optimally, according to validated methods, showed better functional and biochemical improvements. 27 Taken together, the data from the present study and other real-world evaluations support existing evidence that higher intravenous iron doses lead to better haematological responses versus lower doses 15 16 21 and can reduce the need for anaemia retreatment over time. 16 Small bowel and nutrition less iron than their total estimated need, and others may have required even higher amounts of iron.…”

Section: Discussionsupporting

confidence: 86%

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency in patients with gastroenterological disorders

Kearns

Jacob

2020

Frontline Gastroenterol

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BackgroundIn gastroenterological disorders, iron deficiency (ID) is often treated with intravenous iron. This real-world study assessed the effectiveness and safety of iron isomaltoside (IIM), a high-dose intravenous iron, for the treatment of ID in patients with gastroenterological disorders, as part of a service evaluation and improvement process.MethodsMedical records of 117 patients with gastroenterological disorders, who received IIM, were examined retrospectively. Study outcomes included dose of IIM (estimated iron need versus actual dose received), number of appointments required to deliver the dose and changes in haemoglobin (Hb) and ferritin at ~1 month and ~6 months post-treatment. Safety was assessed through adverse drug reactions (ADRs).ResultsOverall, 76.1% of patients received their estimated iron need; 23.9% were underdosed. The mean (SD) iron dose was 1317 (409.7) mg; 62.4% of patients received their dose in one appointment. From baseline, mean (SD) Hb increased by 20.9 (15.4) g/L at 1 month post-treatment (p<0.0001) and by 22.0 (17.9) g/L at 6 months post-treatment (p<0.0001). Mean (SD) baseline ferritin was 26.6 (37.8) μg/L, which increased to 234.6 (142.9) μg/L at 1 month post-treatment (p<0.0001), and remained increased at 6 months post-treatment (122.8 (99.2) μg/L; p<0.0001). A substantial proportion of patients were non-anaemic at 1 month (57.5%) and 6 months (61.8%) post-treatment. At both post-treatment timepoints, the proportion of non-anaemic patients was higher in those receiving their total iron need versus those who were underdosed. No serious ADRs were reported.ConclusionIIM was efficacious and well tolerated in patients with gastroenterological disorders. This real-world study highlights the importance of administering the full iron need to maximise treatment response.

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Section: Discussionsupporting

confidence: 86%

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency in patients with gastroenterological disorders

Kearns

Jacob

2020

Frontline Gastroenterol

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“…Indeed, treatment with a too low dose is associated with less improvement in functional status. [ 45 ] Ongoing studies in patients with stable heart failure will further determine the effect of treatment with IV iron on hard clinical endpoints such as cardiovascular mortality and the risk of hospitalisation for heart failure. Table 2 lists ongoing trials with IV iron in the setting of chronic heart failure.…”

Section: Guidelines For Treating Iron Deficiencymentioning

confidence: 99%

The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction

Martens

2022

Card Fail Rev

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Over the past decade, the detrimental impact of iron deficiency in heart failure with reduced ejection fraction has become abundantly clear, showing a negative impact on functional status, quality of life, cardiac function and structure, exercise capacity and an increased risk of hospitalisation due to heart failure. Mechanistic studies have shown the impact of iron deficiency in altering mitochondrial function and negatively affecting the already altered cardiac energetics in heart failure with reduced ejection fraction. Such failing energetics form the basis of the alterations to cellular myocyte shortening, culminating in reduced systolic function and cardiac performance. The IRON-CRT trials show that ferric carboxymaltose is capable of improving cardiac structure and cardiac performance. This article discusses the effect of iron deficiency on cardiac function and structure and how it can be alleviated.

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“…A recent study has indicated that Ganzoni dose iron may lead to greater improvements in New York Heart Association (NYHA) class (symptoms of heart failure), TSAT, and ferritin levels compared with lower doses in patients with HF. It should be noted, however, that this study was confounded by differing baseline haemoglobin and eGFR in patients receiving Ganzoni dose iron compared with lower doses 20 . Our study, which had more closely matched baseline eGFR and haemoglobin results, demonstrates no statistically significant difference between the two dosing groups.…”

Section: Discussionmentioning

confidence: 45%

A retrospective review examining intravenous iron infusion dosing methods

Winckel

Sullivan

Vongphakdi

et al. 2020

Pharmacy Practice and Res

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Background Careful dosing of intravenous iron is important to minimise consequences of iron deficient anaemia, and avoid complications related to iron overload. Clinician practice regarding dosing varies between settings and specialities. Ganzoni dosing is an individualised calculated dose based on patient details and has traditionally been advocated for, while the fixed‐low dose method provides a method for individuals to receive a lower fixed dose of iron. At present, it is unclear if Ganzoni‐dosing compared with a fixed‐low dose provides greater haemoglobin improvements for iron‐deficient patients with reduced haemoglobin. The aim of this study is to explore whether the choice of intravenous iron dosing method influences improvements in the patient’s haemoglobin concentration. Method A retrospective observational study using real‐world data was carried out to compare Ganzoni and fixed‐low dose patients using a cohort of 79 patients between 1 April 2017 and 25 February 2019. The primary outcome of interest was the change in haemoglobin concentration between baseline (within 0–28 days prior to intravenous iron infusion) and follow‐up (4–12 weeks following intravenous iron infusion). Results The Ganzoni and fixed‐low dose methods indicated similar improvements in haemoglobin concentration (17 and 25 g/L, respectively), with no statistically significant differences identified between the two dosing methods for any other clinical indicators assessed. Conclusion This study has indicated that the fixed‐low dose method may be an appropriate alternative to the Ganzoni dosing method for the dosing of iron polymaltose and ferric carboxymaltose for iron deficient patients with reduced haemoglobin.

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The importance of dose optimisation in the treatment of iron deficiency in heart failure

Cited by 8 publications

References 9 publications

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency in patients with gastroenterological disorders

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency in patients with gastroenterological disorders

The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction

A retrospective review examining intravenous iron infusion dosing methods

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