Intravenous iron therapy can be a lifeline for heart failure patients: Study

Associate Professor David Sim (left) and Madam Sumuthi Nadesan at the National Heart Centre Singapore. PHOTO: NATIONAL HEART CENTRE SINGAPORE

SINGAPORE - A new multinational study on iron deficiency in heart failure patients has found that giving iron intravenously can significantly reduce mortality and rehospitalisation.

Some 6,000 patients are admitted for heart failure each year in Singapore's public sector hospitals alone.

Iron therapy comes as a new lifeline for at least half of them, thanks to the landmark study.

The so called Affirm-AHF (acute heart failure) trials were jointly conducted by researchers from the National Heart Centre Singapore (NHCS) and partners in Europe, the Middle East and South America.

Iron deficiency is common in patients with heart failure and is associated with exercise intolerance, poor quality of life, and increased risk for hospitalisation and mortality.

While there have been previous studies on stable heart failure patients, Affirm-AHF was the first to show reduction in readmission after administration of intravenous (IV) iron, Associate Professor David Sim, senior consultant at the Department of Cardiology at NHCS, told The Straits Times.

A single dose of IV iron takes about 15 minutes to administer and can last patients between six months and a year.

The clinical trials took place from March 2017 to July 2020 across 121 sites, studying the efficacy, safety and outcomes of the IV iron therapy.

IV iron and placebos were randomly administered to 1,100 patients who were aged 18 years or older and hospitalised for acute heart failure and iron deficiency.

Madam Sumuthi Nadesan, a heart failure patient in her 60s, had received the IV iron during the trials.

In 2010, Madam Sumuthi went to the accident and emergency clinic as she was suffering from chest pains. She was then diagnosed with heart failure caused by cardiomyopathy and placed under medication. She stopped her medication after a year, as she was feeling better.

In late 2018, her condition worsened and she was referred to the heart failure team at NHCS.

"My lungs felt heavy and it was difficult to breathe," said Madam Sumuthi.

Prof Sim, who is also the director of the heart failure programme at NHCS, noted that her blood levels were low and recommended that she join the clinical trials for iron therapy.

Madam Sumuthi was admitted and given two doses of IV iron. She was discharged the next day and her condition improved significantly after that.

Results from the clinical trials showed that the IV iron treatment was safe and reduced the risk of recurrent heart failure hospitalisations.

When asked about the possibility of excessive iron causing heart failure, Prof Sim said that happens only in patients with haematological disorders, who require regular blood transfusion.

"Iron therapy does not result in excess iron because it is given only when there is proven iron deficiency in the patient, and the status of iron deficiency is re-checked before giving subsequent doses," he added.

The research findings have since been translated into clinical practice at NHCS.

"We have started this therapy on suitable patients in NHCS, and it is well tolerated with minimal side effects. Most patients will experience a better quality of life and exercise capacity after the treatment," said Prof Sim.

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