Professor Phil Kalra

60-minute iron treatment averts heart failure hospital admissions

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

Nearly one million people in the UK are living with heart failure, where the heart can’t pump blood around the body as well as it should. This can leave people struggling with everyday tasks and, as their symptoms worsen, can lead to long stays in hospital. Around one in 10 people will die during a heart failure hospital admission in the UK.

Our bodies need iron to work properly, and it’s vital for our cells to produce energy. Up to half of people 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.

Now, researchers have shown that an intravenous iron infusion (where iron is delivered into a vein via a drip) is a safe and effective way to reduce the risk of hospitalisation for heart failure in people with the condition, with most people only requiring treatment every one to two years.

The IRONMAN study, funded by the British Heart Foundation, has been published in The Lancet. 75 patients from Northern Care Alliance NHS Foundation Trust hospitals (Salford Royal and the Royal Oldham) took part in the study, alongside 63 from Manchester University NHS Foundation Trust (Manchester Royal Infirmary and Wythenshawe Hospital). 70 UK trusts were involved.

Regular assessment

Professor Paul Kalra, consultant cardiologist at Portsmouth Hospitals University NHS Trust, led the 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.”

In the study, 1,137 people with heart failure and low iron levels received either intravenous iron infusions or their usual care. Participants visited hospital every four months where they had their iron levels measured, and people in the iron group were given an infusion if their levels were low. Iron was given via an intravenous drip over 30 minutes and people stayed for 30 minutes afterwards for observation.

People in the study were followed-up for an average of 2.7 years. The majority (78 per cent) of the iron group received just one or two intravenous iron infusions during this time.

The researchers found that iron infusions reduced the risk of hospitalisation due to heart failure and dying from a heart related cause by 18 per cent compared to usual care. People who received iron infusions also reported a better quality of life at four months.

Professor Paul Kalra continued: “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.”

Landmark study

Professor Phil Kalra (pictured), NCA Director of Research and Innovation who led the study at Salford Royal and who was one of the co-organisers of the study with his brother, Paul, said: “IRONMAN is a landmark trial for the UK and intravenous iron should now be recognised as a key part of the standard of care for the 40-50% of heart failure patients who have evidence of iron deficiency. This treatment not only improves hospitalisations as shown in IRONMAN, but earlier studies have shown large benefits in quality of life and functionality which are equally important to our patients.”

Dr Fozia Ahmed, Consultant Cardiologist at MFT, was Principal Investigator for the study at MFT and is also NIHR Clinical Research Network Greater Manchester Specialty Lead for Cardiovascular Disease.

She said: “The global heart research community has been eagerly awaiting the results of this UK study in which Greater Manchester has played such a significant role. Almost 140 participants have taken part across four of our local hospitals and we are extremely grateful to them all.  It has been an honour and a privilege for our teams to be able to contribute to what has been the largest study to date looking at the impact of intravenous iron in heart failure patients.“

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, 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.”

This research was also supported by Pharmacosmos.

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