Short-Term Effects & Safety of an Accelerated Intravenous Iron Regimen in Patients With Heart Failure

Phase 4

Completed

Brief Summary: Intravenous iron replacement has been shown to benefit patients with heart failure and iron deficiency, but the weekly outpatient regimens studied to date are impractical for many patients. Our purpose is to evaluate the short-term effects and safety of an accelerated intravenous iron regimen in hospitalized patients with these two conditions.

Detailed Description: The purpose of this pilot investigation is to evaluate the short-term hematologic effects and safety of an accelerated intravenous iron regimen in patients with heart failure and iron deficiency. Recent investigations have demonstrated improved clinical outcomes with the use of intravenous iron therapy in this patient population, but a weekly regimen administered to ambulatory patients may be inconvenient, impractical, and associated with less than optimal adherence rates for many patients, especially those with reduced functional capacity. The heart failure population is characterized by frequent hospitalizations, which would make an accelerated inpatient regimen a convenient and attractive option for improving heart failure symptoms, exercise tolerance, and quality of life. Accelerated regimens have been demonstrated as being both safe and effective in other patient populations, but no studies to date have evaluated this strategy in hospitalized patients with heart failure.

Recruitment & Eligibility

Inclusion Criteria

Age > 18 years
Admission to the general cardiology or heart failure services and under the care of a cardiologist at the study institution
New York Heart Association Class II-IV heart failure
Ejection fraction < 40%
Serum hemoglobin < 12.0 g/dL
Ferritin < 100 ng/mL or 100-300 ng/mL with transferrin saturation (TSAT) < 20%
Patients deemed by an attending physician to require intravenous iron therapy based on previous attempts to correct iron deficiency or other patient-specific circumstances

Exclusion Criteria

Anemia of other known etiology (e.g., malignancy, malabsorption syndromes)
Use of iron or erythropoietin-stimulating agents within previous 12 weeks
Blood transfusion within previous 12 weeks; additionally, if patients receive blood transfusions during the study period, they will remain in the safety analysis but will be excluded from efficacy analysis
Active bleeding
Known infection at admission
Immunosuppressant therapy
Renal replacement therapy
Known pregnancy
Any other criteria deemed by the attending physician to warrant exclusion

Arm && Interventions

Group	Intervention	Description
Sodium ferric gluconate	Sodium ferric gluconate	Sodium ferric gluconate 250 mg administered intravenously every 12 hours until iron repletion completed (as determined by Ganzoni equation) or patient discharge, whichever comes first.

Primary Outcome Measures

Name	Time	Method
Serum Hemoglobin Concentration	Baseline and at follow-up within 1-4 weeks	Change in serum hemoglobin concentration compared to baseline and at follow-up within 1-4 weeks after last intravenous iron infusion

Secondary Outcome Measures

Name	Time	Method
Serum Ferritin Level	Baseline and at follow-up within 1-4 weeks	Change in serum ferritin level compared to baseline and at follow-up within 1-4 weeks after last intravenous iron infusion
Transferrin Saturation	Baseline and at follow-up within 1-4 weeks	Change in transferrin saturation compared to baseline and at follow-up within 1-4 weeks after last intravenous iron infusion