A Meta-Analysis of IV Iron Repletion in Heart Failure with Reduced Ejection Fraction

Iron repletion lowered risk for a composite endpoint of HF hospitalization or cardiovascular death, without safety concerns.

The evidence for the value of intravenous (IV) iron repletion in individuals with heart failure (HF) and iron deficiency — with and without anemia — is conflicting. Three trials, including the recently published FAIR-HF2 trial, found qualitative benefits but narrowly missed statistical significance (NEJM JW Cardiol Apr 9 2025 and JAMA 2025 Mar 30; [e-pub]). In this patient-level meta-analysis of 6 published randomized trials, researchers randomized some 7200 individuals with HF with reduced left ventricular ejection fraction (HFrEF) to receive IV iron (ferric carboxymaltose in 5 trials, ferric derisomaltose in 1) or placebo. Half of the patients had anemia.

After a median follow-up ranging from 6 to 32 months, individuals receiving iron repl…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, MACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)