Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/33053
Title: The importance of dose optimisation in the treatment of iron deficiency in heart failure
Authors: Martens, Pieter
Minten, Lennert
DUPONT, Matthias 
MULLENS, Wilfried 
Issue Date: 2020
Publisher: TAYLOR & FRANCIS LTD
Source: ACTA CARDIOLOGICA, 75 (6) , p. 520 -524
Abstract: Background: Treatment with ferric carboxymaltose (FCM) is limited to 1 g during one administration, which is insufficient in patients with a higher body weight or low haemoglobin (Hb). As a consequence, under-dosing might be common in clinical practice, yet the consequences remain unstudied. Methods: We retrospectively assessed all HFrEF-patients with iron-deficiency (ferritin <100 mu g/l or between 100 and 300 mu g/l if TSAT < 20%) receiving treatment with FCM between 2015 and 2017. This time-frame was chosen as during this we used a 1-g FCM-regimen for all patients (unless Hb = 14-15 mg/dl, than 500 mg). We compared the actual given dose versus the calculated target dose (according to the SmPC, with the difference between both being the dose deficit). We assessed the impact of dose deficits on clinical and biochemical status after 12 weeks. Results: A total of 211 HFrEF patients were analysed. The actual given dose FCM was 918 +/- 188 mg, while the calculated target dose was 1308 +/- 470 mg. In 121(61%) patients, a standard dose of 1-g FCM resulted in a dose deficit, of whom 93 had a dose deficit of 500 mg and 35 had a dose deficit of 1000 mg. Follow-up was available in 81% of patients (median = 12 weeks). A dose deficit of 500 mg was associated with a 4.93 higher odds, while a dose deficit of 1000 mg was associated with a 7.78 higher odds of residual iron deficiency. After adjusting for baseline NYHA-class, a dose deficit was associated with less symptomatic improvement. During 442 +/- 292 days of follow-up, 68 patients were readmitted with heart failure and 15 patients died. In an univariate model (but not in a multivariate model), a dose deficit was associated with adverse clinical outcome. Conclusion: A majority of HFrEF patients with iron deficiency require doses exceeding 1 g of FCM, and thus require follow-up appointments to correct a residual dose deficit. A residual dose deficit is associated with less functional and biochemical improvement.
Notes: Martens, P (corresponding author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium.
Pieter.martens2@zol.be
Other: Martens, P (corresponding author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. Pieter.martens2@zol.be
Keywords: Iron deficiency;heart failure;treatment;ferric-carboxymaltose;co-morbidities;outcome
Document URI: http://hdl.handle.net/1942/33053
ISSN: 0001-5385
e-ISSN: 1784-973X
DOI: 10.1080/00015385.2019.1625554
ISI #: WOS:000589568200006
Rights: 2021 Informa UK Limited.
Category: A1
Type: Journal Contribution
Validations: ecoom 2021
Appears in Collections:Research publications

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