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Cardiovascular hospitalisation and death by subgroup in iron-deficient patients with heart failure treated with intravenous ferric carboxymaltose: an individual patient meta-analysis.
Authors : S D Anker (Gottingen,DE), M Boehm (Homburg/Saar,DE), J Comin-Colet (Barcelona,ES), G Filippatos (Athens,GR), B Roubert (Glattbrugg,CH), DJ Van Veldhuisen (Groningen,NL), P Ponikowski (Wroclaw,PL)
Background: Treatment with intravenous (i.v.) iron as ferric carboxymaltose (FCM) has been shown to reduce the rate of cardiovascular (CV) hospitalisation and CV death in an individual patient data meta-analysis of patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID). The impact of these outcomes for treatment with FCM vs placebo on key subgroups is unknown.
Purpose: To examine the rates of CV hospitalisation and CV death in subgroups for patients treated with FCM vs placebo.
Methods: An individual patient data meta-analysis was performed, based on 4 randomised, double-blind trials comparing i.v. FCM vs placebo, each of 12–52 weeks duration. Patients were analysed by age, gender, left ventricular ejection fraction (LVEF), anaemic status, transferrin saturation (TSAT) value, estimated glomerular filtration rate (eGFR), aetiology of heart failure (HF), history of diabetes, and New York Heart Association (NYHA) class at baseline. Rates of events were calculated per 100 patient years and analysed using a log-link negative binomial regression model.
Results: The analysis included 839 patients, 504 on FCM vs 335 on placebo. Rates of CV hospitalisation or CV death numerically favoured treatment with FCM in all subgroups except TSAT ≥20 with significant differences observed in patients who were ≥70 years, male, LVEF <34%, haemoglobin <12.0 g/dL, TSAT <20.0%, had renal dysfunction, HF of ischaemic aetiology, negative history of diabetes or NYHA class ≥III. (Table).
Conclusions: In patients with HFrEF and ID, treatment with i.v. FCM improves the rate of CV hospitalisation and CV death across subgroups.
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