Iron infusion could cut heart failure hospital admissions, study suggests

Receiving an iron infusion every one to two years could help people with heart failure avoid being admitted to hospital, new research suggests.

Nearly one million people in the UK are living with heart failure, where the heart cannot pump blood around the body as well as it should, and can face long stays in hospital if their symptoms worsen.

Up to half of those with heart failure also have low iron levels and this has been linked to worse symptoms, lower quality of life, and greater risk of hospitalisation and death, the British Heart Foundation (BHF) said.

In the study, funded by BHF, 1,137 people with heart failure and low iron levels received either intravenous iron infusions or their usual care.

The researchers found iron infusions reduced the risk of hospitalisation due to heart failure and dying from a heart related cause by 18% compared to usual care.

People who received iron infusions also reported a better quality of life at four months.

Professor Paul Kalra, honorary clinical senior lecturer at the University of Glasgow and consultant cardiologist at Portsmouth Hospitals University NHS Trust, led the Ironman study.

He said: “The Ironman trial shows for the first time the longer-term benefits and safety of intravenous iron treatment in heart failure, adding to the growing evidence of its favourable effects.

“We should now be recommending that, in people with heart failure, regular assessment of iron status is performed and treatment given if iron deficiency is found. Now is an opportune time to update national clinical guidelines.

“Despite great advances in treatment and care in recent decades, many people with heart failure still have symptoms that impact their daily lives and rates of hospital admissions remain high.

“We’ve shown that as little as one 60-minute treatment, repeated when needed, can be enough for most people with heart failure to top up their iron levels, help improve their wellbeing and keep them out of hospital.

“Treatment with intravenous iron can make a real difference to patients, and this is on top of our other treatments.”

BHF said around one in 10 people will die during a heart failure hospital admission in the UK.

Drip system
The patients received intravenous iron infusions (Alamy/PA)

In the study, which looked at data from August 2016 to October 2021, participants visited hospital every four months where they had their iron levels measured, and people in the iron group were given an infusion through an intravenous drip if their levels were low.

People in the study, which is published in The Lancet, were followed up for an average of 2.7 years.

The majority (78%) of the iron group received just one or two intravenous iron infusions during this time.

The Covid-19 pandemic had an impact on the trial as it affected people’s ability and willingness to visit hospitals, which meant some patients may have missed out on having an iron infusion.

Because of this, the researchers also looked at the data from the 1,063 people who were part of the trial before March 31, 2020 and whose treatment would not have been as affected by the pandemic.

This analysis showed a stronger benefit of iron infusions over usual care, with the risk of hospitalisation due to heart failure and dying of a heart related cause 24% lower in the iron group compared to usual care.

Professor Sir Nilesh Samani, medical director at the BHF, said: “Heart failure is a debilitating condition, often requiring recurrent and prolonged hospitalisations.

“At a time when the NHS is under more pressure than ever, this straightforward and inexpensive treatment not only helps patients with heart failure feel better, but by reducing the need for hospitalisation can also free up extra time and beds to help tackle the growing backlog of heart care.”