British Society for Heart Failure welcomes results of first and largest long-term trial to study intravenous iron in heart failure – just announced at American Heart Association meeting

British Society for Heart Failure welcomes the results of

IRONMAN

First and largest long-term trial to study IV iron in heart failure

Results announced at American Heart Association Annual Meeting 2022

and published in The Lancet^[i]

• IRONMAN demonstrates correction of iron deficiency with intravenous iron infusion (given into a vein) reduces the risk of hospitalisation due to heart failure and dying from a heart related cause by 18% compared to usual care
  • People who received iron infusions also reported a better quality of life at four months
• Iron deficiency (low iron levels) is common in patients with heart failure with reduced ejection fraction (HFrEF), affecting 30 to 50% of patients and is associated with worse symptoms ^[ii], reduced quality of life and greater risk of hospitalisation
• Heart failure is a growing societal issue: at least 1 million people are affected by heart failure in the UK with a further 200,000 newly diagnosed each year^[iii]
• The British Society for Heart Failure ‘Freedom from Failure’ – The F word’ campaign raises awareness of self-recognition of the common symptoms of heart failure (fatigue, feeling breathless, filling with fluid) and seeking medical advice early to improve outcomes

The results of the first long term randomised controlled trial to study intravenous iron on hard end points in heart failure with reduced ejection fraction (HFrEF) were announced at the American Heart Association Annual Meeting 2022. Professor Paul Kalra, Consultant Cardiologist at Portsmouth Hospitals University NHS Trust and honorary senior lecturer at the University of Glasgow; former Chair of the British Society for Heart Failure (BSH) and Chief Investigator for the IRONMAN study (funded by the British Heart Foundation), revealed the results to the nearly 18,000 strong professional audience in Chicago. The British Society for Heart Failure (BSH), the professional association for heart failure care in the UK, welcomes the results of the study.

Professor Kalra commented: “Iron deficiency is a major heart failure co-morbidity present in up to half of outpatients with heart failure irrespective of the left ventricular function. Along with an association with risk of hospital admission for heart failure and death, iron deficiency, independent of anaemia^[iv], also reduces quality of life patients’ lives. IRONMAN, the largest intravenous iron study in heart failure worldwide to complete to date, recruited 1,137 patients from 70 sites across the UK, despite the CoViD-19 pandemic.  Overall, the results give us a clear mandate to firstly assess patients for iron deficiency, and then in those in whom it is present treat it with intravenous iron infusion. We hope these data will help change clinical practice and guidance”.

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. It is a condition that tends to get slowly worse over time to severely limit activities and compromise quality of life. As the endpoint of almost all cardiovascular diseases, the risk of death from heart failure is higher than for some of the most common cancers^[v], therefore, heart failure should be recognised, detected, and treated with the same urgency as a disease as malignant as cancer^[vi]. Iron deficiency is a major co-morbidity present in more than half of patients with stable heart failure irrespective of the left ventricular function. Along with increasing patient morbidity and mortality, iron deficiency, independent of anaemia^[vii], is thought to contribute to the symptoms people experience, including fighting for breath and fatigue, and reduces quality of life.

BSH Past-Chair, Professor Simon Williams, Consultant Cardiologist, Heart Failure Specialist, Wythenshawe Hospital, Manchester; co-author of a retrospective cohort study of 80,000 people with ID admitted with heart failure across England^[viii], said: “For adults admitted to hospitals in England, principally with acute heart failure, iron deficiency and iron deficiency anaemia are significant comorbidities and associated with adverse outcomes, both for affected individuals, and the health economy. It is important to appropriately management iron deficiency to help people to live better with heart failure. Outcomes for those with heart failure can be dramatically improved through earlier, faster diagnosis, specialist referral and expediting optimal treatment onto guideline recommended therapies^[ix]. This is an important aim of the care we provide as Heart Failure Specialists.”