142 The impact of ferric derisomaltose in people with heart failure with or without ischaemic heart disease in the ironman trial

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Introduction An individual patient data (IPD) meta-analysis of randomised trials of intravenous (IV) ferric carboxymaltose for patients with heart failure and a reduced ejection fraction (HFrEF), showed the effect on HF hospitalisation and cardiovascular (CV) death tended to be greater in patients with ischaemic heart disease (IHD) compared to those without. There is also gathering evidence that supports the use of transferrin saturation (TSAT) to guide iron treatment in preference to serum ferritin. Methods IRONMAN included patients with HFrEF (LVEF ≤45%) and serum ferritin <100 µg/L or TSAT<20%, 647 (57%) of whom had IHD as reported by the local investigator. Patients were randomised, open-label, to FDI (ischaemic n=331; non-ischaemic n=238) or usual care (ischaemic n=316; non-ischaemic n=252) and followed for a median of 2.6 years. Results Patients with IHD were more likely to be men and diabetic, less likely to have been recruited during hospitalisation or have a history of atrial fibrillation and had a higher LVEF (median 35% vs 31% respectively, p=0.025) and TSAT (16%, IQR 11–20 vs 14% IQR 10–19) (table 1). There was no difference in baseline haemoglobin and the increment in haemoglobin at 4 months in those allocated to FDI was similar according to aetiology (mean change 0.8 (SD 1.3) g/dl and 0.8 (SD 1.3) g/dl for IHD and non-IHD). Minnesota Living with Heart Failure (MLWHF) quality-of-life score at 4 months improved in people randomised to FDI with an ischaemic (-5, 95% CI -9 to 0) and non-ischaemic (-2, 95% CI -8 to 3) aetiology (p for interaction 0.51). The reduction in the rate of the primary endpoint, recurrent hospitalisation for heart failure and cardiovascular death, was somewhat greater for those with IHD assigned to FDI (RR 0.76, 95% CI 0.58–1.00) compared to no-IHD (RR 0.88, 95% CI 0.62–1.25), but this was not significant (p for interaction 0.52). All-cause first hospitalisation was reduced for those with IHD assigned to FDI (HR 0.78, 95% CI 0.64–0.94) but not for those with no-IHD (HR 1.08, 95% CI 0.86–1.35; p for interaction 0.030). For patients with IHD and TSAT<20% (n = 471), there were fewer primary endpoint events, CV deaths and all-cause mortality but these differences did not reach significance (table 2). Conclusion For patients with HFrEF in the IRONMAN trial, FDI is associated with a trend to greater benefit in those with IHD, consistent with similar (non-significant) trends observed in the IPD meta-analysis. Acknowledgements The study was funded by the British Heart Foundation (grant award CS/15/1/31175). Pharmacosmos provided supplies of intravenous ferric derisomaltose and additional trial support with an unrestricted grant. We thank the participants, and all the staff who contributed to the IRONMAN trial. Conflict of Interest None

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