Early Intravenous Iron Sucrose Supplementation for Absolute Iron Deficiency in Acute Heart Failure in the Emergency Department: A Single-Center Randomized Pilot Study

• Khadija ZAOUCHE

  University Tunis El Manar, Faculty of Medecine of Tunis. Tunisia

• Mohamed Amine Kallel

  Tunis El Manar University

• Asma Chargui

  Tunis El Manar University

• Manel Kallel

  Tunis El Manar University

• Radhia Boubaker

  Tunis El Manar University

• Hamida Maghraoui

  Tunis El Manar University

Background

Iron deficiency is frequent in heart failure and is associated with impaired functional capacity and poorer outcomes, independently of anemia. Evidence remains limited in emergency department patients with acute heart failure, particularly with intravenous iron sucrose.

Aim

This pilot study assessed the feasibility, safety, and exploratory short-term clinical value of intravenous iron sucrose in emergency department patients with acute heart failure and absolute iron deficiency.

Methods

We conducted a prospective, randomized, open-label, single-center pilot study in the emergency department of a university-affiliated teaching hospital in Tunisia, from August 2017 to June 2018. Adults admitted for acute heart failure with absolute iron deficiency, defined as serum ferritin <100 µg/L, were randomized to receive either a single 200 mg dose of intravenous iron sucrose plus oral iron for three months or oral iron alone. Primary outcomes were change in six-minute walk test distance and correction of absolute iron deficiency at three months. Secondary outcomes included NYHA class, fatigue score, emergency department revisits, rehospitalizations, length of stay, and mortality as an exploratory outcome.

Results

Among 510 patients admitted for acute heart failure, 114 with absolute iron deficiency were included: 60 in the intravenous iron group and 54 in the oral iron group. Mean age was 66 ± 7 years, and 65 patients were male. Baseline ferritin and six-minute walk distance were comparable between groups. No in-hospital deaths, shock, cardiac arrest, invasive mechanical ventilation, allergic reactions, or anaphylaxis occurred. At three months, mean six-minute walk distance improvement was greater in the intravenous iron group than in the oral iron group (+43 m vs +11 m; p=0.01), and improvement was observed in 81% versus 38% of patients, respectively (p<0.001). Correction of absolute iron deficiency was more frequent with intravenous iron but was not statistically significant (65% vs 51%; p=0.16). NYHA class, emergency department revisits, and rehospitalizations did not differ significantly. Lower three-month mortality in the intravenous iron group was considered exploratory.

Conclusions

A single 200 mg dose of intravenous iron sucrose added to oral iron therapy was feasible, well tolerated, and associated with greater improvement in six-minute walk distance at three months. Larger, prospectively registered multicenter trials are needed.

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