Effect of ferric carboxymaltose on hospitalization and mortality outcomes in chronic heart failure: A meta-analysis

Introduction: Iron administration especially intravenous iron therapy is associated with improvements in exercise capacity and quality of life in patients with chronic heart failure (CHF). Our aim was to assess effect of ferric carboxymaltose (FCM) on hospitalization and mortality outcomes in CHF.

Materials and methods: A literature search across PUBMED, Google Scholar and trials database www.clinicaltrials.gov was conducted to search for randomized controlled trials (till August 2016) comparing FCM to placebo in CHF with or without anaemia. Published human studies in English language which reported data on mortality and hospitalization rates were included. Primary outcome was rates of HF hospitalizations and secondary outcomes were hospitalization due to any cardiovascular (CV) cause, death due to worsening HF and any CV death.

Results: From 17 studies identified, two were included in final analysis (n=760; 455 in FCM and 305 in placebo arms). We observed significantly lower rates of hospitalization for worsening HF in FCM arm [Risk Ratio (RR) 0.34, 95% confidence interval (CI) 0.19, 0.59, p=0.0001] as well as for any CV hospitalizations [RR 0.49, 95% CI 0.35, 0.70; p<0.0001] (figure). No heterogeneity in studies was seen for these two outcomes (I²=0%, p>0.05). No significant treatment effect with FCM was noted in mortality from worsening HF (RR 0.41, 95% CI 0.02, 7.36; p=0.55) or any CV death (RR 0.80, 95% CI 0.40, 1.57; p=0.51).

Conclusion: FCM reduces hospitalization rates in CHF but may not reduce mortality outcome. This finding needs further evaluation in a large, prospective, randomized controlled trial.