Efficacy of ferric carboxymaltose in heart failure with iron deficiency: an individual patient data meta-analysis

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(48), P. 5077 - 5091

Published: Aug. 26, 2023

Whereas a beneficial effect of intravenous ferric carboxymaltose (FCM) on symptoms and exercise capacity among patients with iron deficiency heart failure (HF) has been consistently demonstrated, the effects treatment clinical events remain subject research. This meta-analysis aimed to characterize FCM therapy hospitalizations mortality.Patient-level data from randomized, placebo-controlled trials including adults HF ≥52 weeks follow-up were analysed. The co-primary efficacy endpoints (i) composite total/recurrent cardiovascular death (ii) total death, through 52 weeks. Key secondary included individual endpoint components. Event rates analysed using negative binomial model. Treatment-emergent adverse also examined.Three 4501 included. Ferric was associated significantly reduced risk 1 (rate ratio 0.86; 95% confidence interval 0.75-0.98; P = .029; Cochran Q: 0.008), trend towards reduction 2 0.87; 0.75-1.01; .076; 0.024). Treatment appeared result hospitalization rates, not improved survival. have good safety profile well tolerated.In iron-deficient left ventricular ejection fraction, hospital admissions for causes, no apparent mortality.

Language: Английский

---

2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 83(15), P. 1444 - 1488

Published: March 8, 2024

Language: Английский

---

2024 update in heart failure

ESC Heart Failure, Journal Year: 2024, Volume and Issue: unknown

Published: May 28, 2024

Abstract In the last years, major progress has occurred in heart failure (HF) management. The 2023 ESC focused update of 2021 HF guidelines introduced new key recommendations based on results years science. First, two drugs, sodium–glucose co‐transporter‐2 (SGLT2) inhibitors and finerenone, a novel nonsteroidal, selective mineralocorticoid receptor antagonist (MRA), are recommended for prevention patients with diabetic chronic kidney disease (CKD). Second, SGLT2 now treatment across entire left ventricular ejection fraction spectrum. benefits quadruple therapy reduced (HFrEF) well established. Its rapid early up‐titration along close follow‐up frequent clinical laboratory re‐assessment after an episode acute (the so‐called ‘high‐intensity care’ strategy) was associated better outcomes STRONG‐HF trial. Patients experiencing worsening might require fifth drug, vericiguat. STEP‐HFpEF‐DM STEP‐HFpEF trials, semaglutide 2.4 mg once weekly administered 1 year decreased body weight significantly improved quality life 6 min walk distance obese preserved (HFpEF) or without history diabetes. Further data safety efficacy, including also hard endpoints, needed to support addition acetazolamide hydrochlorothiazide standard diuretic regimen hospitalized due HF. meantime, PUSH‐AHF supported use natriuresis‐guided therapy. options most recent evidence HF, specific drugs cardiomyopathies (i.e., mavacamten hypertrophic cardiomyopathy tafamidis transthyretin cardiac amyloidosis), device therapies, contractility modulation percutaneous valvulopathies, finding from TRILUMINATE Pivotal trial, reviewed this article.

Language: Английский

---

Contemporary pharmacological treatment and management of heart failure

Nature Reviews Cardiology, Journal Year: 2024, Volume and Issue: 21(8), P. 545 - 555

Published: March 26, 2024

Language: Английский

---

Intravenous iron for heart failure, iron deficiency definitions, and clinical response: the IRONMAN trial

European Heart Journal, Journal Year: 2024, Volume and Issue: 45(16), P. 1410 - 1426

Published: March 6, 2024

Abstract Background and Aims What is the relationship between blood tests for iron deficiency, including anaemia, response to intravenous in patients with heart failure? Methods In IRONMAN trial, 1137 failure, ejection fraction ≤ 45%, either serum ferritin < 100 µg/L or transferrin saturation (TSAT) 20% were randomized ferric derisomaltose (FDI) usual care. Relationships investigated baseline anaemia severity, TSAT, changes haemoglobin from 4 months, Minnesota Living Heart Failure (MLwHF) score 6-minute walk distance achieved at clinical events, failure hospitalization (recurrent) cardiovascular death. Results The rise after administering FDI, adjusted care, was greater lower TSAT (Pinteraction .0001) = .028) more severe .014). MLwHF scores months somewhat (better) FDI anaemic (overall Pinteraction .14; physical .085; emotional .043) but not related ferritin. Blood did predict difference walking those compared control. absence of a ≥ associated event rates little evidence benefit FDI. More 20%, especially when ≥100 µg/L, higher absolute reductions events albeit statistically significant. Conclusions This hypothesis-generating analysis suggests that > might identify who obtain iron. interpretation requires confirmation.

Language: Английский

---

Rationale and design of the FAIR‐HF2‐DZHK05 trial: Ferric carboxymaltose assessment of morbidity and mortality in patients with iron deficiency and chronic heart failure

European Journal of Heart Failure, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 28, 2025

Abstract Aims While it is widely accepted that intravenous (IV) iron improves functional capacity, symptoms, and cardiovascular outcomes in patients with heart failure (HF) reduced ejection fraction (HFrEF) diagnosed deficiency (ID), three recently published outcome trials (AFFIRM‐AHF, IRONMAN HEART‐FID) of IV supplementation HF failed to demonstrate a significant benefit on their respective primary endpoints. Dosing after the initial correction baseline ID – by design or as result trial circumstances was relatively low (i.e. <500 mg/year). The objective FAIR‐HF2 evaluate treatment effect ferric carboxymaltose (FCM) compared placebo ambulatory HFrEF using higher dose during follow‐up >1000 second study create prospective evidence for fulfilling new definition HF, i.e. those transferrin saturation <20%. Methods an investigator‐initiated, multicentre, randomized, double‐blind, placebo‐controlled has recruited 1105 chronic left ventricular ≤45% concomitant ID, defined serum ferritin <100 ng/ml 100–299 Patients were consented randomized receive either FCM (treatment) saline (placebo). During estimated median over 2 years, underwent repletion maintenance phase, up 2000 mg, followed 500 mg every 4 months unless stop criteria haemoglobin >16 mg/dl >800 are met repeat visits. will hypotheses: (i) time first event death hospitalization (ii) rate total (first recurrent) hospitalizations (both analysed full population), (iii) <20% at baseline. familywise type I error across endpoint hypotheses be controlled Hochberg procedure (alpha 0.05). Conclusion efficacy improving utilizing more aggressive approach towards ensuring prevention transitional targets have been met.

Language: Английский

---

Contemporary American and European Guidelines for Heart Failure Management

JACC Heart Failure, Journal Year: 2024, Volume and Issue: 12(5), P. 810 - 825

Published: March 13, 2024

Language: Английский

---

Redefining Iron Deficiency in Patients With Chronic Heart Failure

Circulation, Journal Year: 2024, Volume and Issue: 150(2), P. 151 - 161

Published: May 11, 2024

A serum ferritin level <15 to 20 μg/L historically identified patients who had absent bone marrow iron stores, but levels are distorted by the systemic inflammatory states seen in with chronic kidney disease or heart failure. As a result, nearly 25 years ago, diagnostic threshold was increased 5- 20-fold (ie, deficiency if <100 μg/L, regardless of transferrin saturation [TSAT], 100 299 TSAT <20%). This guidance motivated not findings studies total body tissue depletion, desire encourage use supplements potentiate response erythropoiesis-stimulating agents renal anemia. However, failure, this definition does reliably identify an absolute functional iron-deficiency state, and it includes individuals TSATs (≥20%) normal range (20-100 mg/L) deficient, have excellent prognosis, do respond favorably therapy. Furthermore, may be both neprilysin sodium-glucose cotransporter 2 inhibitors, which act mobilize endogenous stores. The most evidence-based trial-tested is presence hypoferremia, as reflected <20%. These hypoferremic generally deficient on examination, after intravenous therapy, they exhibit improvement exercise tolerance capacity (when meaningfully impaired) show marked reduction 20%-30%) risk cardiovascular death failure hospitalizations. Therefore, we propose that current ferritin-driven should abandoned based hypoferremia (TSAT <20%) adopted.

Language: Английский

---

Differences in presentation, diagnosis and management of heart failure in women. A scientific statement of the Heart Failure Association of the ESC

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(8), P. 1669 - 1686

Published: May 23, 2024

Despite the progress in care of individuals with heart failure (HF), important sex disparities knowledge and management remain, covering all aspects syndrome, from aetiology pathophysiology to treatment. Important distinctions phenotypic presentation are widely known, but mechanisms behind these differences only partially defined. The impact sex-specific conditions predisposition HF has gained progressive interest community. Under-recruitment women large randomized clinical trials continued more recent studies despite epidemiological data no longer reporting any substantial difference lifetime risk prognosis between sexes. Target dose medications criteria for device eligibility derived a predominance men, whereas specific information is lacking. present scientific statement encompasses whole scenario available evidence on sex-disparities aims define most challenging urgent residual gaps communities.

Language: Английский

---

Iron deficiency and supplementation in heart failure

Nature Reviews Cardiology, Journal Year: 2024, Volume and Issue: 21(7), P. 463 - 486

Published: Feb. 7, 2024

Language: Английский

---