A multidisciplinary panel of leading UK specialists has come to together to raise awareness of the under-recognised condition of anaemia associated with chronic heart failure, which has a significant impact on quality of life and survival, yet remains under-diagnosed and under-treated in the UK. The experts have assessed the evidence available to date and developed a pragmatic algorithm to help guide investigation as well as effective treatment of anaemia associated with chronic heart failure, which was published on 31 August 2011 in the British Journal of Cardiology.
The advisory statement highlights how the FAIR-HF (Ferinject Assessment in patients with iron deficiency and chronic heart failure) trial provides sound evidence for the potential for an intravenous iron treatment strategy to improve symptoms and quality of life for patients with chronic heart failure and iron deficiency. Furthermore, the panel supports the introduction of intravenous iron – which can be given over a short period of time and is well-tolerated – as a far more attractive therapy option to oral iron or erythropoiesis-stimulating agents (ESAs).
Over a third (34%) of patients with chronic heart failure are suffering from anaemia, which is not only contributes to poorer quality of life, but may also contribute to disease progression. While the cause of anaemia is not always easily identified, a common cause is iron deficiency, and iron deficient anaemia is associated with the severity of heart failure, impairment of renal function, and other comorbidities. Anaemia is an independent predictor of mortality and of acute hospital admissions, and is also associated with exercise limitation, therefore correction of anaemia is an appealing strategy for both patients and the health service.
Paul Kalra, consultant cardiologist at Portsmouth Hospitals NHS Trust, and chair of the advisory panel, states “We have reviewed the information available to date on evaluating and managing anaemia associated with chronic heart failure with the aim of creating a pathway that ensures patients are considered for appropriate investigation and treatment. The best data relate to the potential benefit of intravenous iron replacement for patients with iron deficient anaemia. The consensus view is that at present there is not strong enough evidence to recommend ESA therapy until data from an ongoing large scale study (RED-HF) are available. With respect to iron replenishment, there are many well documented issues associated with oral iron therapy including impaired tolerability and efficacy. In contrast, modern formulations of intravenous iron have excellent safety profile, are well tolerated by patients, as well as being quick and straight forward to administer. This therefore is often the most appropriate treatment option for patients.”
Kalra comments further “Despite improvements in care of patients with chronic heart failure, many patients suffer extremely poor quality of life with limiting symptoms and/or recurrent hospitalisations. In the FAIR-HF study – the largest randomised study to date – Ferinject was associated with improved symptom status, quality of life and exercise capability in patients with chronic heart failure when added to established drug therapies. There was a further suggestion that it might help reduce hospital admissions but this needs further clarification. The ease and flexibility of administration also makes it an attractive option to the clinician.”
Ferinject (ferric carboxymaltose), an intravenous iron for the treatment of IDA when oral iron preparations are ineffective or cannot be used, has a proven efficacy and safety profile that has been demonstrated through several large clinical trials confirming that up to 1000mg of Ferinject can be administered without a test dose in 15 minutes. This offers a significant advance for patients and healthcare professionals over Venofer (iron sucrose), which requires five separate hospital visits to administer the same dose of 1000mg of iron.
Ferinject has recently received approval from the Medicines and Healthcare products Regulatory Agency (MHRA) of the UK for a new, simplified dosing regimen, which eliminates the need to calculate the iron dose with the complex Ganzoni formula, meaning it can now be delivered in a standardised cumulative dose of 1000mg, 1500mg or 2000mg of iron, depending on the individual patient’s body weight and stratified Hb level. Furthermore, the maximum amount of Ferinject that can now be administered in a single intravenous injection has been increased from 200mg to 1000mg iron, excluding haemodialysis-dependent chronic kidney disease. This gives clinicians greater flexibility and allows them to treat a larger patient population than before with a single dose.