What are the possible risks and benefits of IV iron for people with HFREF and iron deficiency?
IV iron for people with HFREF and iron deficiency appears to have a clinically important benefit on quality of life and haemoglobin levels (in people with anaemia). However, the impact on mortality is unclear. The committee noted that while the point estimate showed a clinically important reduction in deaths, the confidence intervals around the absolute effect were wide, reducing their confidence in the effect estimate. In addition, the committee noted that the trials had only included people with reduced ejection fraction, so there was a lack of evidence in people with iron deficiency and HFPEF. Trade-off between clinical benefits and harms were also discussed, with discontinuation and adverse event rates with oral iron appearing low (difference against placebo was less than 50 per 1000 for all 3 outcomes) and no evidence was identified for anaphylaxis or hypersensitivity.