Intravenous Iron Therapy in Patients Admitted With Acute Heart Failure and Iron Deficiency: A Systematic Review and Meta-Analysis.

The role of intravenous (IV) iron in chronic heart failure (HF) has been well studied, becoming a class IA recommendation. However, its role in acute heart failure (AHF) is less well-known. Multiple studies, including randomized controlled trials (RCTs), have been published; however, their clinical benefit remains controversial. We aim to provide enough evidence to support decision-making in this clinical scenario. We performed a systematic review and meta-analysis of IV iron in patients admitted with AHF and iron deficiency (ID). PubMed, Embase, Scopus, and Cochrane databases were searched for trials published up to July 1, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled across trials. Outcomes included HF and all-cause re-hospitalization, all-cause mortality, and mean change in hemoglobin levels. Of the 362 database results, three RCTs, six observational studies, and 3,588 patients were included. In total, 1,622 (45.2%) patients received IV iron. Re-hospitalization for HF (RR = 0.96; 95% CI = 0.76-1.21; p = 0.74; I² = 74%) showed a downward trend, but this was not statistically significant. Neither was all-cause rehospitalization (RR = 1.03; 95% CI = 0.90-1.19; p = 0.64; I² = 3%) nor all-cause mortality (RR = 1.00; 95% CI = 0.81-1.24; p = 0.87; I² = 0%). A statistically significant mean change in the hemoglobin levels (MD = 0.80; 95% CI = 0.33-1.27; p = 0.0003; I² = 88%) was documented between both groups. In patients with AHF and ID, treatment with IV iron improves hemoglobin levels. Yet, this improvement does not appear to have a significant impact on rehospitalization or all-cause mortality rates. Larger RCTs are needed to further study its effect on clinical outcomes.