Intravenous Iron Sucrose for Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Iron Deficiency

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Background: The concurrent presence of iron deficiency (ID) and heart failure (HF) can worsen prognosis and reduce the quality of life for affected individuals. This study aimed to explore the effects of incorporating iron sucrose into standard HF treatments for patients with acute decompensated HF and ID. Methods: We prospectively enrolled 65 hospitalized HF patients, all with a left ventricular ejection fraction of ≤40% and ID, defined as ferritin levels below 100 ng/mL or ferritin levels between 100 and 299 ng/mL with transferrin saturation below 20%. Patients were randomized into two groups: the iron sucrose group, who received intravenous iron sucrose in addition to the standard HF treatment; a control group who received standard HF treatment alone serum ferritin, iron, transferrin saturation, and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were measured at baseline and a 4-week follow-up. Results: Baseline characteristics, iron profiles, and KCCQ scores were comparable between the two groups. At 4 weeks, patients in the iron sucrose group possessed significantly higher serum ferritin levels than those in the control group (ferritin 485.3 ± 269.7 ng/mL vs. 225.5 ± 162.5 ng/mL, p < 0.001; Δferritin 382.2 ± 243.5 ng/mL vs. 97.4 ± 143.0 ng/mL, p < 0.001, respectively). Only 9.1% of patients in the iron sucrose group remained within the ID criteria, compared to 36.7% in the control group (p = 0.012). The ΔKCCQ score was 10.6 points higher (27.8 ± 19.5 vs. 17.1 ± 17.8 points, p = 0.031) in the iron sucrose group than in the control group. Conclusions: Post-discharge intravenous iron sucrose may improve iron levels and quality of life in HF patients with ID. Clinical trial registration: NCT06703411, https://clinicaltrials.gov/expert-search?term=NCT06703411.

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